HomeMy WebLinkAboutMortgage_West (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
1-is State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: $ ®®®
To be filed in person or by mail with the CountyAudiior or County Recorder of the county where the property is loco p
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. 9 dim
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)mid
before March 31 of each year the deduction is sought - 6 �C1oluyntty Recorder
See reverse side for addition nstrudfons and qualifications. MAY 6 N t t J
• I
__at... luta Applicant(owner or rxntraa b r see reatrlfaorma en - .-ode JI '---v ail
Taxing District 1 Key num.= -!t esaipaon -•:1c' "yi"'xa""r�• iyalk
S�6-1Hoaoo-ooa- oi3- I ISSON COUNTY�+r•
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract inde ess unpaid as of s the appfcant the sole
March 1,anent year March gent year date of application legal or equitable owner?
� b / V(J ❑ 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's different than that of applicant indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually pressed
Mobile home(IC 6-1.1-7)
Name of mortgagee or contras seller E ` 1
,
Address of mortgagee or contract seller(number and street crty,state,and ZIP cede))
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
county applicant own property in any other ' EST '.Eli.;: a for current or been requested on drapery -
❑ Yes ❑ t GLJ 1 Q• year? ❑ Yes ❑ No -
Deduction approved in the amount of NlT. D l� A-
20 20 b - I gt 3 1 20 20
Signature of County Auditor • County Date(month,day,)ear)
I 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.
SI o ems full name) Date(month,day.year)
F &ess of r t aIY state Item
C t ---
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)