HomeMy WebLinkAboutMortgage_Richardson eSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RU/6-09)
- - Prescribed by Department of Loral Government Finance
File Mark
INSTRUC77ONS:
Form filed with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the properly is located.
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. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract verse Re)
T D¢truY Key `rummbben I legal desoiiiption Record number Page nu
air �. a!� � 1 ��/ - ADD . Ob5 -o 01. 7 �o , 3 IYlK
Assessed value of real property as of l Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the%vacant the sole
Math 1,current year I Math 1,current year date of application legal or equitable owner?
130,spouse,indicate with whom
❑ Yes ❑ No
If no,what is hi /her exact share of interest? If owned with someone other
If name on record is different than that of applicant,indicate below. Is he property in question:Annually Assessed
R Real Property ❑Annually Assessed 6-1.1-7)
Name of mortgagee or contract seller 5/3
Address of mortgagee or contract seller(number and sheet,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address assignee(number and street,ciry,ssstt'ffa andZIP code) ,), 7
Does applicant own property in any other If yes, county? What Taring District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No current Yin ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 �� � 20 20 ( —
sgmaof County Aneimt County .D I'a}}'fit' l�i�..c1 ..
I I We certify under the penalty of perjury that the above and foregoing information is tr Card r U ad
owner(contract buyer of the aforementioned property on date application is filed. , 1N o, .. 141/9
Signature(awner'sif 1 na .•)
I I. I _ l,_ 4 ia9,8cn,`n,
Full resident ddressof app6nnt(number and street,city state nd ZIP code)
?‘.
ii IQ W. �f krt}on t? o'e V-nceirn a tr}cin
Person authorized by duty executed r of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city state,and ZIP code)