HomeMy WebLinkAboutMortgage_Burton (4) a„ t: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709
artm/e-W) I�
Presrnbetl by Department of Local Government Finance ;� 1 ��
INSTRUCTIONS: f .i -' r
with:
To be hied in person or by mad with the County Auditor or County Recorder of the county where the property is located. Faro filed
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought *2'®,3 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)mont s
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side fo additional instructions and qualifications.
Appfxant(owner tract buyer-see resrr on reserritaciu 6 SI GIBSON COUNTY AUDITOR
Taring Dist het Key caber//legal f Record nu Pa
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,parent year Mardi ar nt year date of application
legal or equitable DN
-� � ❑ Yes ❑ No
If no,what is his/her exact share of interest? f If owned with someone other than spouse,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
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city:state,and ZIP
Name of assignee or other owner or holder of mortgage _
1 __
• OH. 6-5
Address of assignee(number and /
Does applicant own property in any �i C1 l.l1J(e :trio? Has this deduction been requested on poverty
county in Indiana? ❑ Ye' Drawer NO for current year?
❑ Yes ❑ No
Card NO. 07 C78
Deduction approved in the amount c .
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
e /contract buyer of th aforementioned property on date application is filed.
9 own rlarpd)/�. Date(month,day,year)
lit r
Full ' ent :ITX of app&ant(number and street,city,state,and ZIP code)
•
Person authorized by duly executed Power 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) . rS.1+^vr\_