HomeMy WebLinkAboutMortgage_Folsom (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ! iMISEnlath Year
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FOR DEDUCTION FROM ASSESSED VALUATION ;
tt' State Form 43709(Rh /6-09)
Presaibed by Department of Local Government Finance
APR 2.3 eoiglark
INSTRUCTIONS:
To be filed in by b County county property is beat Form filed with:
person or mail with the Court Auditor or Court Recorder of the tour where the ro
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 twelytl
before March 31 of each year the deduction is sought. OU TY MDR Recorder
See reverse side for additional instrucgttiioo/�nssmand qualifications.
Appfimm aiwcont2a -se/ ) )
T • gQislda Key comber/legal description Record number Page number
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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 appfxant the sole
March 1,anent year March),current year date of application legal or equitable owner?
607b66 , ❑ Yes ❑ No
It no,what is his/her exact sham 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
property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract y ^
O ix
Address of mortgagee or contract seller(number art street,city,state,and ZIP code) __- .__- _ _ _- ---_—
Name of assignee or other owner or holder of mortgage ().1. .
1)1•a\\'Cl \p........
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other If yes,what county? C a 1•c1 N O• •.'' uested on property
county in Indiana? 1.
❑ yes ❑ No ��I ,i I Yes ❑ No
�� I V -
CO
Deduction approved in the amount of:
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
owner I contract buyer of the aforementioned properly on date application is filed.
Signature(owners hitl me Date(month,day,year)
Full resident address of applicant(number and street,city,state,and ZIP code)
Y S:t /7 S S7 eh S7 Q//KLAA/o e / y i/✓ W7"fa
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Y-R1 • i3
Address of author zed person (number and street city,state,and ZIP code) .