HomeMy WebLinkAboutMortgage_Meny (8) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I. Li .'r it ilki
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' FOR DEDUCTION FROM ASSESSED VALUATION
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;1' 1t State Form 43709(R11/6-09)
� >+ Presmbed by Department of Local Government Finance MAR 2 5 2013
File Mark
INSTRUCTIONS:
To be fried in person or by mail with the CountyAuditor or County Recorder of the county where the property is located. HIEiienf ,;
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought GIBS ON ni• r.Y11NA49D1TOR
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought. ❑ County Recorder
See reverse side for additional instructions and qualifications.
MPtroam(owpe woon see onre life)
Ta District Key number/legal desolation Record number Page number
(0- 8-3b-3oo- 0 a. a48 -0014 )3 NU
value of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appraant the sole
1,asrent year March 1,anent year date ofiaillitatthoin legal Dyes ❑ oN
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 applcant.indicate belmv:
n Is the property in question:Annually Assessed
E C 1^ ❑Real Property ❑Annually Assessed
Name of mortgagee or contract seller �J LJ • Mobile Home(IC 61.1-7) .
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage .
Address of assignee(number and street,city,state,and_._—_ _
Does applicant own property in any other N-��OL,L `'' ?y
:�1Y / his deduction been requested on property
county in Indiana?
❑ Yes ❑ No - rtent rear? ❑ Yes ❑ No
xp 1 11- 13 /.�' �
Deduction approved in the amount of
20 20 Bilve 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(owners lutl name) Date(month,day,year)
Full ofgppffcant number arq stree • state,end Lm
P
100014 de) 4 I tl 3 c
Person authorized by duly executed Power of Attoney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ray,state,and ZIP code)