Loading...
HomeMy WebLinkAboutMortgage_Carey f} r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year ,:. FOR DEDUCTION FROM ASSESSED VALUATION ...t, State Form 43709(R11/6-09) -- .. Prescribed by Department of Local Government Finance File Mark INSTRUCTIONS: ai .} To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is loca i �w[ �'I�. Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 1 1I 1 r. editor 2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)mon before March 31 of each year the deduction is sought - ❑ County Recorder See reverse side for additional instructions and qualifications. p,'" 1 I - Ap im t(owner o. r-yeg resucfians on reverse side) Taxing District Ke}number/ ascription n Rea ` - 60 \ tS-too - 003. 75 -Od / . GISSONF NTV Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of is the applicant the sole Mardi 1,ascent year Martin 1,amept o date of appGCation legal or equitable owner? (r/// 1 ❑ Yes ❑ No If no,what is his/her exact share of interest? / ' If owned with someone other than sparse,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 Motile Home(IC 6-1.1-7) Name of mortgagee or contract seller © f 13 Address of mortgagee or contract saber(number and street,cdy,state.and ZIP code) Name of assignee or other owner or holds Address of assignee(number and street r NO a Drawer . Does applicant own property in any other 5 Has this deduction been requested on property county in Indiana? ❑ Yes Card N O. for current year? ❑ Yes ❑ No - Deduction approved in the amount at - 20 20 20 20 20 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 I contract yer of the aforementioned property on date application is filed. (owns e) �/J Date(month,day,Year) ul resident address of app cent(n tuber and sire ti1y,state,and cita Person autho\Jr¢N�y duly exeiuted of Attorney or C 6-1.1-12-0.7 Date(month.day,year) — - — - - Address of authorized person (number and street csy state,and ZIP code) {\