HomeMy WebLinkAboutMortgage_Tate (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County ro hshr r
��„. FOR DEDUCTION FROM ASSESSED VALUATION �..J
; State Form 43709(R11/6-09)
`t. Presaibed by Deparbnent of Local Government Finance /r� 71-'
INSTRUCTIONS: ^� I` 2013
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form Ned with:
Filing Dates: 1) Real Property.Must Me during the year for which the deduction is sought. ,r
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months IMP:..
before March 31 of each year the deduction is sought. - GIBS a N . U • • •.115R
See reverse side for additional instructions and qualifications.
Applicant(• -ror contract• - -see'�'"'`/�/j'on re rasa side)
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Tati ��� Key ber/legal desai P emu ber
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vahre of real propery as d Mortgage/Contract indebtedness unpaid as of I Contract indebtedness unpaid as of Is the appDcent the sole
March 1,=rent year March 1,anent year date of apna--`--^ — legal or equitable owner?
-a00 • ❑ yes 0 N
If no,what is his!her exact share of interest? If owned with somea_••eie•men Spouse.indicate with whom
If name on record is different than that of app&Cant•indicate below. Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract saner r �r
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Address of mortgagee or contract seller(number end I.J'ciryy state,and ZIP code)
Name of assignee or other owner or holder of mortgage Q ) ) 42dL,Address of assignee(number and steel,dry,state,and ZIP code)
Does aroticant own property in any other I If yes,what county? What Taxing District? Has this deduction been requested an property
cow - for current year? ❑ Yes ❑ No
TA- -372)0 sree
COUNTY AUDITOR
Der 99.....,8 q1/459
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
owner I contract buyer of the aforementioned property an date application is filed.
S (owner's AID nor Date(nwtb,day,year)
NiN ` ,fin/,,/,', / Oct JT
Full r iddent of t(number streef,al�ya,and ZIP code)
Person authorized by duty executed Power of Attorney or IC fr1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and so-eat city,state,and ZIP code)