HomeMy WebLinkAboutMortgage_Besing (3) }. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Fmiip
FOR DEDUCTION FROM ASSESSED VALUATION °
l' State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance *II INSTRUCTIONS: nU'ii ` I
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located. Forth��
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. CA.:
2) Mobile/Manufactured Homes not assessed as Real Pm �::-; �!
Property:Must file during the twelve(12)months V!�71aer
before March 31 of each year the deduction is sought. Si a�••
GIB' O O AUDI • ;
See reverse side for additional instructions and qualifications. k
Apprrcant(`y{'r or.. •.-buyer-see - • reverse side)
Taxing Ke number/legal description Record umber Page number� � at -(26 _o76/07) - GO/ _, /�'3 -00/ d6/ ow 9J
Assessed value of real property as of Monpaga/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app9rant the sole
Mardi 1,anent year Mares 1 onset year date of aDPOration f legal or equitable vmefr
/03. duo ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of appacam,indicate below: U
Property in question:Annually Assessed
Real Property ❑Amluagy Assessed
Mobile
Name d mortgagee or contract seller Home CC 6-1.1-7)
Address of mortgagee or contract Seger(number and L say state,and ZIP code)
Name of assignee or other owner or holder of mortgage ///���
Address of assignee(number and sleet dry,state,and ZIP code) / / / / —3.— ? 28 a
-_.�......__ —f..._____.___ountyt `�l�/Whal Taxing Distinct? Has this deduction been requested on property
r . 11 O^j�•CC)
orient year? Yes ❑ No
. 1 ,‘
'h_ _ ;-. t QrvI COUNTY AUDITOR
Dr:awrer NO: .
t.` r ' a I <i n 20 20 20 20
Card NO. "1
S 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.
l` Sig pe e(owner's full name)xn j a,M Date(month,day,year)
Fug resident address of applicant(number and sbae4`Gfy;state,and ZIP code)
C W o
/ leic( 2X)
? ? 5 950 r= 47613
Person 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 street dry state,and ZIP code)
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