HomeMy WebLinkAboutMortgage_Mason (10) ? STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_ , FOR DEDUCTION FROM ASSESSED VALUATION
Y' ' f" State Form 43709(R111609) aq gp
Prescribed by Department of Local Govemment Finance F n p
g 1111 L D File Mark
INSTRUCTIONS:
Form Med with:
To be filed in person or by mad with the County Auditor or County Recorder of the county wh ne f erg43lcated.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. Errounty 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 y� , n ,A� ❑ County Recorder
See reverse side for additional instructions and qualification .
Appruant(owner or r3a r-seere on reve 61DSON COUNTY AUDITOR
_ N C/1� // �C/t�c �. L
\` sjalu jl l/e,(!ro as of �y �i 0 7 -303 -003. ti r S-'oa8 Record/u Page/�numb=i J
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as Is the
March 1,canard year March 1,anrem y96r/ / OO�1 date of aPPgce legal epuitaWereawnerl
'I/Vl (J ❑ Yes ❑ No
tf no,what is his/her exact share of interest? - 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
Name of mortgagee or contract seller
cepannd9:21e. Motile Home(IC 61.1-7)
Address of mortgagee or conbact Seger(number and dly,state,
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,city:state,and Z
Does applicant own property in any other
If D r a l\r e r N O - 0 13 ' ' :this deduction been requested on property
county in Indiana? r urrent yeaR
El Yes ❑ No . • El yes El No
Card NO. a$ o.
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sig = 410,i. ryA .'•r / 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./contract buyer of the aforementioned property on date application is filed.
nature(owners CAI name) Date(month,day,year)
,[/ull�resident ad 000ff as /r�n�t/nuu/mbeberr a//l J(� city,state,and ZIP code)
Person u0rodzed by duty exewtltl Power of Atibmey orby IC 61.1-12-0.7 Date(month,day,yeah w`11`\\
Address of authorized person (number and street,shy,state,and ZIP code) ` _
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