HomeMy WebLinkAboutMortgage_Mason (12) s4. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township h e ar
- ' FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/ft of L
° Presctibed by Department of Local Government Finance
F LE
INSTRUCTIONS: F�r
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located. gl JR'M 013
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. County Auditor
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 er
See reverse side for additional instructions and qualifications. 61 BSON C Oi I NTY AUDITOR
Ap t(owner or con buyer restrictions on reverse side)
ear", Key number/legal .i Record number Page number
y >e�? a &—/a -D-9 - 300 - O0/. S97 - oa7 2013 la o3
Assessed value of real tie of Montage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the epprcant the sole
Marsh 1,current year Mardi 1,curtent year date of application legal or equilade owndl
100000 ❑ Yes El No
n
If no,what Is his/her exact share of interest? If owned with someone other tharr spouse,Indicate with whom
If name on record is different than that of applicant,indicate be1ow: Folproperty in question:Annually Assessed
Real Property ❑Annually Assessed
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�u Mobile Home pC 6-1.1-7)
Name of mortgagee or contract seller v V✓ T F L u
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Add of assignee(number and street,city,state,and ZIP code)
fT w ef- a — ill ? .ay A CJ
Does applicant awn property in any other If yes,what county? What Taxing District? Has this deduction been requested an property
county in Indiana? ❑ Yes ❑ No for arrant year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
DI'a }er N par t-
zo 20 20 20 „ o
.....
Card N /� —
Signature County Auditor • County o. .�....! 1 ..
1/We certify under the penalty of perjury that the above and foregoing information is true and tonnes...._ 7f���/!ODD 1
�" owner/contract buyer of the aforementioned property on date application is filed. "«J
r \ Sig (owner's MI name l Date(month,day,Yam,
Fug resident of a�t(numberr�an�d sheet oily, and ZIP code)
/lo 1(LZ /�l[ la /t[.+ cth t. I A) 4 7(0 70
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-03 Date(month,day,}ear)
Address of authorized person (number and sheet city,state,and ZIP code) .
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