HomeMy WebLinkAboutMortgage_Hurt (4) "' STATEMENT OF MORTGAGE OR CONTRACT INDEB Dgl�p County Township Year
��t,;�- FOR DEDUCTION FROM ASSESSED VALUATION .vv
"`^'•,c� State Form 43709(R11/6-09) •
�` Prescribed by Department of Local Government France ,� .
��11 (1 NO�.° File Mark
INSTRUCTIONS: t,K y
Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county w ere the pro•.r••AI • t OR
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought. • 1 AJO" { County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file durinr�jt,;r -' • /months ��/"`JJJ
before March 31 of each year the deduction is sought - C,OV ❑ County Recorder
See reverse side for additional instructions and qualifications. G,BSON
Apt: mrrl r or contra buyer- e ' ' on reverse side)
tars D' Key num r/legal description Record number Page number
1 nigh 1, (94 l 919 -10t3 -tfz/9r) �a .�) /3 c°5
-•value of real as of Mortgage/Contract ude tedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apP6rant theiale
March 1,current year March9 n year date of applimtion legal or equitable owner?
(//} ❑ 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 apprrcant,indicate below: Is the property in question:Annually Assessed
,yeal Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee antral seller
Address of mortgagee orconbact 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) /)A/ //^r�
Does applicant own property in any other If yes,what county? I r D L'1% d on property _
county in Indiana? c.J
❑ Yes ❑ No /3 •s ❑ No
COUNTY
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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.
SignaatxtTh(�olwnefy11{full nn11raame`-)�1^��/.*��J _ Date(month,day,year)•
Full +dtigt add o a( ppfwant(number ar>d.streer,eL state,laird ZIP code)
/� /P� /_ ,/cfty,Y lQ fy duly tot Atoorley a V'� l L —i L CPR() 7
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)