HomeMy WebLinkAboutMortgage_Beauchamp STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
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,A FOR DEDUCTION FROM ASSESSED VALUATION
�;`��_M1f� State Form 43709(R77/609) .
Prescribed by Department of Local Goverment Finance
File Mark
INSTRUCTIONS: --i t..
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought . r 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 ,,, finel ; aunty Recorder
See reverse side for additional instructions and qualifications. GIBSON C• • ' - • • • 6 =
(owner or contract buyer- restrictions m reverse side) J
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Ta istrict Key number/legal description Record number Page number
,1�e�(,�y� ao-� a - / 9 _ loo -oo5r_ /o9 - od7 / 3 ? 787
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application -7 legal or equitable owner?
2 O 7 9 ! ❑ Yes ❑ No
If no,what is Ns I her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant indicate below Is the properly in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract setter r
Address of mortgagee or contract seller(number and street ciy 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)
Dees applicant own property in any other If yes,what county? - What Tadn Jam) �- TE)2 X 4 —
county th Indiana? ❑ Yes ❑ No
8tauci / • to
COUNTY AUDITOR ./� r� /y�
Deduction appmred in the amount of: ,/
20 20 20 20 - c.. _.
Signs a (County Auditor .�' / County Date(month,day,year)
I/We certify under nalty of perjury that the abobove, and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/ buyer of the en. property on date application is filed.
XSignature( am Date(month,day,year)
�/ Full ent adndress d apprcant(mum rants eet crl state,and ZIP code)
iI 20 ( S. BAST �M i vc sr tJ �l G(JG7O
autlhorm.M by duty executed Purer of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .