HomeMy WebLinkAboutMortgage_Runau 5r. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township _ _ _Year
y;-r FOR DEDUCTION FROM ASSESSED VALUATION _ '•
1}- State Form 43709(R71/6-W) ` 1
Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. M t§ w�b13
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. - , Co "• • ,•• •er
r.See reverse•,;.e for additional instructions and qu- .in tions. '"e, ii
Apt.,.: t .curt-rorcontract buyer-see A(1!• . • re • side) OIBSON COUNTY AUDITOR
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Ta: �'_ '• Key old p' Rem number P umbe
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,aarent year March.1,current year date of application.,�-,
`bb..��Cjy/V/��/ legal or equitable owner?
❑ Yes ❑ No
If 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. s property in question:Annua%Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number and street 1'e,and ZIP code)
Name of assignee or other owner or holder of mortgage nn
Address of assignee(number and street,thy state.and ZIP code 7 , ^ / 7 — �7 / / X16
Does applcanl own property in any other If yes,what county? Y/�ji• What Taxing District?[// Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year?
❑ Yes ❑ No
I /�
Drawer NO — COUNTY AUDITOR.•. (90/3 •..
20 20 20 20
Card NO
• ••• •••••••... County Date(month,day,year)
I I We certify under the penalty on p<.r_., _ i foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on uate application is filed.
ISignature(owne full name) i7 Date(month,day,year)
/`�` r /!/°ref
/' F ' ent address of applicant(number and sheet,may.state,and ZIP code)
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Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street oily,state,and ZIP code) .