HomeMy WebLinkAboutMortgage_Williams (9) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
` ., FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R77/6-09) �F...••,v�I
Prescribed by Department of Local Govemment Finance �•�•�
INSTRUCTIONS:
Form filed with:,
To be Ned in person or by mad with the County Auditor or County Recorder of the county where the property is located.
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Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. a P tj 9c2011,3Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications.
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App&rant(owner or contra Myer-see restrictions on reverse side) (1.11—f-}7-4-0"w4-)-
,L' �•_- �NTY AUDITOR
c: oA//,, x} -r-cvrr�Y
Ta District Key number/legal description Record number Page number
0'0 ��J� ��1'f�� a& _ ii— / V - 10u� - o°�. / Si - oat ? 2.00 }- (0 i9S
Assessed value d real property Ss of Mort gage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the sole
Mauch 1,current year March 1,amen year date of application legal cam eeeoowner?
er
If no,what is his/her exact snare of interest? If owned with someone s 0 ❑ Yes ❑ No
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spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in Question:Annually Assessed
rReal Property ❑Annually Assessed
Si Mobile Home(IC 61.1-7)
or Name of mortgagee contract seller 3
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
•
Acid of assignee(number and street,pry,state,and LP code) (�
Does applicant other If ysk,what 2)7a SI '- ' D t-:1\1 C 1-.N O PI"- • .
county in Indiana? !ty? What Taxing District? /
0 Yes 0 No tt &I95"
Card NC).
1
COUNTYAUDITOR A 30,000 pp
Deduction approved in the amount of: 'W ---
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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/contract buyer of the aforementioned property on date application is filed.
Sign( fte p�e/s full / I rC�624-.c-r.+--n1, Date(month,day.year)
�/ Full`eresi resident address of applicant(number and street.ary,star and ZIP code)
' 4Zi I7 r.�II- 00S, PirL..c itJ /.l1.- 4476 7 0
Person authorized by duly exeaf of Attorney or by IC 61.1-12-0.7 / Date(month,day,year)
Address of authorized person (number and street city state,and ZIP code)