HomeMy WebLinkAboutMortgage_Straw (2) f:
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
''rid� f" State Form 43709(R11/6-09)
�-- Prescribed by Department of Local Government Fuwlce �(
INSTRUCTIONS:
y3p1/f File Mark
To be filed in person or b mail with the County Auditor or County Recorder county where t Form tiled
Y ty ty ljy{MgPedY is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is t. ��U�t'�' ❑ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must nrig the twelve(12 months
before March 31 of each year the deduction is sought. ❑ County Recorder
See reverse side for additional instructions and qualifications. • ,ytrflft'��buyer-see restrictions on weas-- ;dej Applicant lownero�mwarl[7 ` Dt2,0 43 GOS0,C'�UN A��ITOR
Taxi,• ristrut Key number/legal description number Page number
t ! / , . t5"/ 9 -oa f "o /3 /_ i
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,amid year Mareliy Wrtp♦(ace date of application legal or equitable owner?
c=f) 6/ lL/� ❑ 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 Is the property in question:Annually Assessed
❑Real Property ❑Armuafy Assessed
Motile Flare(IC 6-l.1-7)
Name of mortgagee or VW seller
Address of mortgagee or contract seiner(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state.and ZIP code) .O I • ••••
Does applicarn own property in any other If yes,what county? D l ray;Cl red on property
county m Indiana?
1:1 yes ❑ No 1ak. es ❑ No
COUNTYr
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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.
na (owners full name) Date(month,day,year)eside
!). 06 3` �7d 70r30X15 0zue,Sd.%/e,-2h1/4/Wr
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 - _ Date(month,day,year)
Address of authorized person (number and vivacity.stare,and ZIP code)