Mortgage_Disney STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coup IlaArilaral.Mill
FOR DEDUCTION FROM ASSESSED VALUATION
r^ t" Slate Form 43709(ft11/6-09)
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Presaited by Department of Local Government Finance
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INSTRUCTIONS:
To be filed in by County County county property F. n:••
person or b mail with the Coun Auditor or Coun Recorder of the coun where the m is boated.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 1144,. 1.0147-S1go,itor .
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)monthPIB'•N •V
_
before March 31 of each year the deduction is sought. Cbum)/neneJUR
See reverse side for additional instructions and qualifications.
Apple,(carer buyer-see reJerbe site)
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Tap �/ K /d1—'CXJ i —lA/O. () / `•-�`^ O ��.f 1 �� q-6 umeer
Assessed value d real • as of Mortgage/Contract indebtedness unpaid as of Mortgage/Con�q indebtedness unpaid r/ras of VIs the apitannt the sole
Mardi 1,anent year March 1.current year date of applica // •. legal or equitable owner?
lU(C/ ❑ Yes ❑ No
If no,what is his/her exact share of interest? I If owned with soiree other indicate with whom
If name on record is different than that of applicant.Indicate below: S the eapPp eini r ty qu esti❑on:Annuaty Assessed
Mobile HAsse(IC 6
n // Mobile Flouts(IC 6-1.1-7)
Name of mortgagee or contract seller 1-// V /4
Address of mortgagee or contract seller(number and SIT/3e4 city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,slate,and ZIP. if /
Ail
/ Z-0-/o -6742e,
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for arrant year?
❑ yes ❑ No
• - COUNTY AUDITOR
Deduction approved in the amount of: — ——
_� 20 20 20 20
prav;er N0•.........
County Date(month,day,year)
car \(�. ....... .foregoing information is true and correct and that the applicant is a resident of Indiana and
I C ,ti. ate application is filed.
I t.1 5 .J ll" Date(month,day,year) •
1{` FiAlesident of a t(number and 4 city,state,and ZIP code)
1( )r� uJA� Si TRIpa�,J IN Ll 7670 •
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-17.7 Date(month,day,year)
—
Address of authorized person (number and street,city,state,and ZIP code) - -