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HomeMy WebLinkAboutMortgage_Komosa -a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R11/6-09) Presaibed by Department of Local Government Finance :: Mark INSTRUCTIONS: gy( i�red wick To be filed in person or by mail with the County Auditor or County Recorder of the county where the p I t . Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought. ❑ County Auditor 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12) 1 months 2� ❑ before March 31 of each year the deduction is sought - MAY 1 County Recorder See reverse side for additional instructions and qualifications. Applicant(owner or..w buyer-see on reverse site) }( oµ ;n% fl I rn `� r AUD170R Taxing District `"� number/legal asap�.1�/�/3 �1 .��'p7SON C�� Page number Assessed valve of real-acpery as of��— © Contract indebtedness oV-af�a o indebtedness unpaid Ias Is the_t�2 Marsh 1.anent year March 1, l rr ON) date of application legal or equitable owned? I ❑ Yes ❑ No If no,what is his/her exact share of interest? l If owned with someone other than spouse,indicate with whom If name on record is different than that of appecant,indicate below Is the property in question:Annually Assessed ❑Real Property ❑Annually Assessed Mobile Horne QC 6-1.1-7) Name of mortgagee or contract seller `/v� D 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 I If yes,what county? What Taring District? Has this deduction been requested on property . county in Indiana? ID yes El No for aarent yeah ❑ Yes ❑ No I COUNTY AUDITOR I- Deducdon approved N the annum of: 20 20 20 20 20 _ 20 20 Signature of County Auditor • 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. (owner's tun name) Q g /f Date(monN.day,year) off resident address of applicant(number and street cly,sta -and ZIP code) Person authorized by duty execrated Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and street,rily,state,and ZIP code) r _-- _