HomeMy WebLinkAboutMortgage_Shoulders (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
1 t State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: i.. iiiii
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ;Iii
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twee(12)months
before March 31 of each year the deduction is sought. - ❑ County Recorder
See reverse side for additional instructions and qualifications.
Appflan (own or.. trac(buyer-seere ,{■,�,:.. on revs side) I —a/ A.IV S - .At A• �/� .Ii - 1. ! ' J_ _ :ww!i-
D' Ken'ill .. /legal e_.-,'. -
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Assessed value of real property 4s of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,=rent year March 1,an-tern year date of application legal equitable owner?
.3 or S 1 GD ❑ Yes ❑ No
If no,what a his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on records different than that of epos:ant.indicate below: Is the openYi in ueston:Annually
❑Real Property ❑Armualhy Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n- r'n r 1 1__ _ --
Address of mortgagee or contract seller(number and sb
Name of assignee or other owner or holder of mortgage 1 / 3
Drawer NO
Address of assignee(number and street,city,state,and �/I
Does applicant own property in any other Card 1\O. / O Has this deduction been requested on property
county in Indiana? ❑ Yea ❑ No for current year'?
❑ Yes ❑ No
35 . 10
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor - County Date(month,day,sear) -
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.
n Q ie) `'V.°` — Dist nxnar.daY•YeaO yvios
e yass of ( ut,city,state. IP � 70
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 city,state,and ZIP code) .