HomeMy WebLinkAboutMortgage_Coleman -,1. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION I
State Fonn 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: APR 1 C_ el
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly'is fed.
Fenn Ned with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought.
2)Mobile/Manufactured Homes not ascnssed as Real Property Must file duri he Iwe 1 tks County Auditor
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instru�ui oonsand ggqualifications. //��— //nGIB�ONCOU'1/NTYAUDITOR buyer-see ApPr�m(owgar oro9nQ2po_-1' swear 14,7n) \ /JT r/l l
T g Di trio n/ I legal E� / 07 V CO � Record n der P1 CJ O,
Assessed value d real property as of t� Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,accent year March 1,current year date of application legal or equitable owner?
8g300 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant indicate below
Is property in question:Annually Assessed
.__ __ Real Property ❑AnruallyAssessed
Mobie Hone(IC 6-1.1-7)
Name of mortgagee ocmolpC suer a
Address of mortgagee or contract seller(number and sin ;03
Drawer NO ///��1
Name of assignee or other owner or holder of mortgage /N,/�2_
Address of assignee(number and street,
Card \O /((/
ssig ( 1.tiff:state,and.
Does applicant own property in any other If yes,what county? What Taring District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for anent year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the annum 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/con ct buyer of the afore . ed rty on date application is filed.
Signature h fW nap � , � Date(month,day,year)
FFyI Ant address of a yi nben arW street state,and LP " )
YO/ i1 C-4i5.rpr/5 t4S?6cJe1U Site 3 y
Person authorized by dtdy executed Power of Attorney or by IC 1.1-12-0.7 Date(month,day,year
Address of authorized person (number and street,city,state,and ZIP code)