HomeMy WebLinkAboutMortgage_Halbig (7) �.}, : STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-; FOR DEDUCTION FROM ASSESSED VALUATION
t Slate Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the ro � 1
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. � Iij County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the trbe( ) oat s I
before March 31 of each year the deduction is sought. - g . County Recorder
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See reverse side for additional instructions and qualifications. ^r R O 2'2013
Applicant(owner or co a buyer-see restrictions on to e F+I 2' C
Taxing District Ke number l legalption ` ' umber/,,,Page giber
a76- 3 -DID-a00 -D•0. oa3-0(C! �=G (�(�u OR 76g4
Assessed valued real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/6 Atrtfe�dabtedness unpaid as of ls the appfmant the sole
March 1,current year March 1,wrtegtpyb V date of application legal or equitable owner?_
C�?! ❑ Yes ❑ No
If no,what is his/her exact share of interest? `/ If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /� r/f
ct yU
Address of mortgagee or contract seller(number and street,citstate,and ZIP code)
Name of assignee or other owner or holder of mortgage _
Address of assignee(number and sheet city:s/819,and ZIP code _ _
Does applicant own property in any other If yes,v �1Q Iy� -I�this deduction been requested on property
musty in Indiana? ❑ Yes ❑ No I ,K I '/(� tavern Yew ❑ Yes ❑ No
J
ai
Deduction approved in the amount of n i V� `-'
ed
20 20 20 d— ' �q 20 20
Signature of County Auditor - County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(o rs NI p 0/��C//�'9' ) Date(month,day,Yeah
f Lo/3
Full addr d a t ,umber a t cry,stare,and ZIP code
uthomEd by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,state,and ZIP code) •ryA\
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