HomeMy WebLinkAboutMortgage_Burst 44 . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
y FOR DEDUCTION FROM ASSESSED VALUATION
-s.,4� Slate Form 43709(R11/6-09)
Presented by Department of Local Government Finance �i
File Mark
INSTRUCTIONS:
Fonn Ned with:
To be tiled in person or by mad with the County Auditor or County Reco of the county yyhp&e properly is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction i 66%pI'® �.0"' County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property. fil/during the ties (12)months
before March 31 of each year the deduction is sought.
.i County Recorder
See reverse side for additional instructions and qualifications. • I \j OR
App/p/f'p[Q`�n✓tt(owner or buyer- ee �1��ns,,anre side)r OVN(Y PVD
an Knumber lr/s pGOn ON C
Record number P ge number
a .I/ - /3 -07602-W9,57/ -oc,7 /a 4/9.3
Assessed�tof real property as of Mortgage/Contract indebtedness unpaid as of mu,,age/Contract indebtedness unpaid as of Is the applicant the e
Manah 1, year March 1,current year_., date of application legal ore equitable owner?
// Q 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 drfierent than that of applicant,indicate below:
Is the property in question:Annually Assessed
C CJ 1 Property ❑Annually Assessed
- Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract setter(/�J N�1/(J�
Address of mortgagee or contract selrer(number and sheet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage —{- — r ^ r� ,, ) -2
Li l?S1r OA/Ll e J
Address of assignee(number and street city,slate,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing Di
county in Indiana?
Ai ❑ Yes ❑ No
el /C) --471q■Z/ Jo
�WA'SSA�O/ COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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 I contract buyer of the aforementioned property on date application is filed.
re (a name) ����) / Date(month.daY.Y�)
Full rev ent ad of appliant numbers t 're,and ZIP code)
'—I 1 �.� . IA-r a�( e -r c-t-I-o:1, T gJ q x 70
Person authorized by duty executed Power of Adorne or by IC 6-1.1-12-0.7 Date(month,day,year)
•
Address of authorized person (number and street dry,state,and ZIP code)
1