HomeMy WebLinkAboutMortgage_Seaton STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CtluutyI papip Year
.FOR DEDUCTION FROM ASSESSED VALUATION
f State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
APR iliki/2913
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly located is locate Form filed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. only Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)d ths- Q
before March 31 of each year the deduction is sought. - U N C4U Y Dill Wiarder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
(
Taring District Key number/legal description Record number Page nu
m atp- II- I- H+00000 ic sto- oat 01O/3 //
Assessed value of real property as of Mortgage/ tract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,argent year March 1,current year date pkapplicat legal or equitable owner?
Vi r 60 ❑ 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` 50 Real property in question:Annually Assessed
IYI Real Property ❑Annually Assessed
T Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5)
Address of mortgagee or contract seller(number and street,coy,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 I 20_ 20 J 20
Signature of Canty Auditor i,day,year)
I I We certify under the penalty of perjury that the above and for - 1 resident of Indiana and
owner/contract buyer of the aforementioned property on date t D I'a wt r NO <O(3
319- -. .wne/s lull name)
h,day,Year)
Fun ,-went address ofappfrant(number and street,&y,state,and ZIP a Card -NO.
1 3 J` lc L5 Oilik IA 5 /0= Oa
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.' ��(��' th,day,year)
Address of authorized person (number and sweet city;stater,and ZIP code)