HomeMy WebLinkAboutMortgage_Faith (2) . .,..„,%,..c., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
l State Form 43709(R11/6-09)
Prescribed by Department of Loral Government Finance INSTRUCTIONS: I" ���To be filed in person or by mad with the CountyAuditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must tile during the year for which the deduction is sought. AA n unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)month
Pr( 2
before March 31 of each year the deduction is sought. - unty Recorder
See reverse side for additional instructions and qualifications.
Appfrant(owner or oonuafcrb - msrrictionsmreve )
GIB
See
AUDITOR
i,
Key number/I desctiption Record nu P number /
6_,aQl� viol ao 3 97 a °a Y / S
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the
Marts 1.accent year March 1.current date of applkation aPP�^t the rte
�/ may-, legal or equitable owner?
Qpo ❑ 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 appUwil indicate below: Is the property in question:Annually Assessed
year Property ❑An Asse(sssed
6-1.1-7)
Name of tract y rr „/
Address of mortgagee or contract seller(number and street,city,state,and ZIP rode)_ _ _ — - - - —--—
Name of assignee or other owner or holder of mortgage 3
O
Address of assignee(number and street,city state,and ZIP cc Drawer I. 0
Does applicant own property in any other If yes.r 'eduction been requested m
county in Indiana? Card NO. ...... . .•.•••••••. t yeah rag property
❑ Yes ❑ No ❑ yes ❑ No
Deduction approved in the amount 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 I contract buyer of the aforementioned property on date application is filed.
Sigrmtjy`(ow MI name) (`�''.' �,1/\1�\ Date(month,day,year)
Full resident of a numbe�steet,city}stae,and ZIP code) }-
1 .5 Oi-k G.,-W 1 V102Y1C - PO 'tI\c �\o ,r\ 1 t-fl (.,-13
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,city state,and ZIP code) .