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HomeMy WebLinkAboutMortgage_Fisher (5) t :47. - STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year I FOR DEDUCTION FROM ASSESSED VALUATION t:i`, ll State Form 43709(R11/6-09) Presaibed by Department of Load Government Finance File Mark INSTRUCTIONS: . . To be bled in person or by mail with the County Auditor or County Recorder of the county where the property is local Fi fp:..1 Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought r ;t tor 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 - /'1 9. County Recorder See reverse side for additional instructions and qualifications. JV I 111 3 Applicant(• ocpnl..buyer -- ••. on re s I e) i / ! / Taring District r Ke/ ben I legal description '��r17[l.^(�(,� Gies, 1!CO•••=w ..P enumbefr� (24 - ri -la- W4- ©a� . g30 - Da8 IJFTYA' iekcl Assessed value of real properly as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole March 1,aurent year March Ic�current year date of application legal or equitable owner?L.aoo Is. -. If no,what is his/her exact share of interest? If owned with someone other than spouse,tad— with •• L 30 1 If name on record is different than that of applicant•indicate below Is the pro•- in question:Annually Assessed ❑Real ••perty ❑AnnuallyAssessed • ,..n... - QC 6- -s Name of mortgagee or contract seller wv _ t E/a I,�, Address of mortgagee or contract seller(number and street, it city? and ZIP ccodde)e)(/��/1M1.�-'GJ ',� (' ,�-i Name of assignee or other owner or holder of mortgage Address of assignee(number and street,aryl state,and ZIP code) Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested on property . county in Indiana? ❑ Yes ❑ No fur current Yew ❑ Yes ❑ No - COUNTY AUDITOR Deduction approved 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 er/contract buyer of the aforementioned property on date application is filed. (owners nem(,.Q 0 Date(month,day,year) ant address of applicant(number and street,city,state,and ZIP code) Person authored 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)