HomeMy WebLinkAboutMortgage_Brines STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun �!hi
FOR DEDUCTION FROM ASSESSED VALUATION - �� hip 11�'r I
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State Form 43709(RD I 6-09)
Prescribed by Department of Local Government Finance
Fillththr6 2013
INSTRUCTIONS: Form Aed wits
To be filed 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. 1�
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+ for
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months G1:, 0'LV�7. rer
before March 31 of each year the deduction is sought O 'R4Q9teFTOR
See reverse side for additional instructions and qualifications.
Applicant( or contract buyer- restrictions on reverse side) numbet
Taxing D. -
(/a 6Kel ner..o goo 3 - coo.a 410-008 Record nunn r all0 7
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appraant the sole
March 1,=rent year March 7,anent yearn date of aPP�raton legal or equibde amen
1 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate below Is the property in question:Annually Assessed
(, i ( ❑Real Properly ❑AnnuallyAssessed
�1 If Mobde Home pC 6-1.1-7)
Name of mortgagee or contract seller
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 Taxing District? Has this deduction been requested on property _
county in Indiana? an
❑ Yes ❑ No for suntan year?
❑ Yes ❑ No
COUNTY AUDITOR -
Deducdon approved in the amount at
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 I contract buyer of the aforementioned property on date application is filed.
a, -/wteYS full n ) . Date(month,day,year)
F —'•en address fopp`fi-FailJ/(nnumbber and sheet�l{y-3�ate,and LP mole) �j�� .) &
II ip 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,seam,and ZIP code) .