HomeMy WebLinkAboutMortgage_Ravellette (2) r,°,: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year -
_N FOR DEDUCTION FROM ASSESSED VALUATION
is State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance F I Leg
INSTRUCTIONS: Form filed vritlu
To be filed in person or by mall with the County Auditor or County Recorder of the county where the property is located. nn
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought MA 2 gi2 ����
llwunty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications. ir 1 -eft gj ji
Applicant wnerorcCa ar t buyer buyeriespeStAcraS OnverSsed 06 i GIBS IN COUNTY AUDITOR
Taxing trill Key number/legal description Record number Page number
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Assessed value of real property Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appkant the sole
March 1,amnt year March 1,current year data of aPpfrcation legal or equitable owner?
b0a010 ❑ 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 applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Amwaay Pressed
. Motile Horne(IC 61.1-7)
Name of mortgagee or contract seller —
Address of mortgagee or contract seller(number and street.city,state,and ZIP cede)
Name of assignee or other owner or holder of mortgage
Add of assignee(number and street ray,state,and ZIP code)
VT SL se 35 —/ —// 5'- O S A-
Does applicant own property in any other If yes,what county? What Taxing District? lies Ws deduction been requested on property .
county in Indiana? ❑ yes ❑ No ( __ anent Yew ❑ Yes ❑ No -
COUNTY AUDITOR • 1 r(j��r I
Deduction approved in the amount of: Drawer NO ' —•20 20 20 20 Card V`CY. ..: 24#1 8 sr° —
Signs f County Auditor. County 54 El s. I —
I
I/We/We certify 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 aforement/iJonned.prooppeerrtty/1�on�date application s filed.
X Signa�wners f l name) ,� YC/L/1A Date(moth,day,year)
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}/ Full resident address appkant(number and street city,state,and ZIP code)
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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) .