HomeMy WebLinkAboutMortgage_Brewer (2) a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou i,:7trintii y ear
"-rs.44 FOR DEDUCTION FROM ASSESSED VALUATION i i : `fir/
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
J ttii Ma(7(013
INSTRUCTIONS: Form Ned with:
To be tiled 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 I.,• ':Mill:
ty Auditor
2) Mobile March 31 of ach year the deduction is sought Must file during the twelve(12)mg¢�ON CO��Teo` ®y�er
See reverse side for additional instructions and qualifications.
or conuact see ante )
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Assessed value of real i as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
3iaoo Dyes ❑ No
If no,what is his/her exact sham 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 ❑AmwaiyAssessed
. Motile Home QC 6-l.1-7)
Name of mortgagee or se
Address of mortgagee or contact 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)
Drawer NO...... \3...
Does applicant own property in any other If yes,what county in requested an property
county in Indiana? ❑ Yes ❑ No
2500 ❑ Yes ❑ No
Card NO.
approved 3' /Z17�. - (-
Deduction a In the amount 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.
save owne/syp narpe) Date(month,day,year)
resident address of applicant(nand street city sbte,and ZIP code)
-G/a2- E Cot AS flans•,
authorized by duty executed Power of Attorney or by 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) •