HomeMy WebLinkAboutMortgage_Frederick (2) aSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'f'- °- FOR DEDUCTION FROM ASSESSED VALUATION
-�" )° State Form 43709(R11/6-09)
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Prescribed by Department of Local Government Finance F
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. F D-
Filing Dates: I) Real Property Must file during the year for which the deduction is sought. El County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months MA
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before March 31 of each year the deduction is sought. Q¢9ttnty Recorder
See reverse side for additional instructions and qualifications.
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Taxing District Key number/legal desaip' Record number (,;Glitter
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appflc ant the sole
Marti 1,current year Ma 1,ar^�°� 7, date of application legal or equitable owner?
I (p ��(J ❑ Yes ❑ No
If no what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
tt name on record is different than that of app&ant,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 n -A q a, 1
Address of mortgagee or contract seller(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)
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 current year? - ❑ No
❑ Yes
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of Canty Auditor County Date(month,day,year)
t/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 da application is filed.
Sig.one(. -114.4 Date(month,day,year)
•
Full'address of appacant(nu street,city,state,and ZIP code)
awn 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 sheet,city,state,and ZIP code) .