HomeMy WebLinkAboutMortgage_Hunt (9) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is 1 o m N
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought - ditra
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)m s
before March 31 of each year the deduction is sought. - ❑ County Recorder
See reverse side foradditio "nstructions and qualifications. APR 4 n�b,2 2013
App&ant(owner or contact buye see restrictions on reverse the)
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Key numrb�erI esaP�n b q _'wim%. 01.1777.. e
AA 0 10 _ la, -DS-p�QQ co 3. 91 a-P ON COUNTY •UDIT
Assessed value of real as of /Conrail indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app�t the sole
March L aired year Mamh 1 year ''\\ date of aPPrimlion legal ar equitable owner?
�v ❑ Yes ❑ No
If no,what¢his!her exact share of interest? If owned with someone filer than spouse,indurate with whom
If name on record is deferent than that of appbcan4 indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city, t and ZIP code)
Name of assignee or other owner or holder of mortgage
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Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other . .___�„�? Has this deduction been requested on property
county in Indiana? ❑ Yes [ NUN r Su s for anent yeaR
�./t ❑ Yes ❑ No
0Duc ion approved in amount of: T — 171 °
Deduction
20_ 20 3 20_ 20
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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 ntract buyer of the aforementioned property on date application is filed.
(owner's 5-
full name))�v-' Date(month,day,year)
Full resident address of applicant(number and sheet,city state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,)ear)
Address of authorized person (number and street,city,state,and ZIP code) _