HomeMy WebLinkAboutMortgage_Pyle (2) f.}, . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION_ I`
j't State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
ile Mark
INSTRUCTIONS: Form fled with:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the props 1
.Filing Dates: 1) Real Property Must file dining the year for which the deduction is sought. JUN 1 1 U I \ County 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 - a County Recorder
.i
See reverse side for additional instructions and qualifications. , , 1117119.
Ape/want(owner abuya, se:resu+cnonsmreve side,)) �N COUNTY AUDITOR•
yl
n�� yn 4 leea=tion/a-o7-/Qq oa- /07; -or nt3 Pa9ase
Assessed value&real property as of Mortgage I�antraa indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1.anent year March 1,r`ry('r73�t date of application legal or equitable owner?
oc) ❑ 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 applicant,indicate below Is the property in quest n:Annually Assessed
❑Real Property ❑Annually Assessed
Motile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgag or con'
ntract seller tuber and street coy,state,and ZIP code) , /
•---a
Name of assignee or other owner or holder of mortgage '
Address of assignee(number and street may,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? ❑ Yes ❑ No for current year? ❑ Yes ❑ No -
COUNTY AUDITOR !-
Deduction approved in the amount at
20 20 20 20 20 20 20
I
I• I .iIar �,I / 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
Amer I contract buyer of the aforementioned property on date application is filed.
Signature(o es rim) R Py�/ Date(month,day,Haar)
Full i d C of a t(nt(nbAandStree4 ay,,state,and LP code)
1[' if .? n/,�/1rn cc4f 9/ /)r1 he. cog, -n/ et 746.-70
Person authorized by duty exacts• Power of Attorney or by IC 6-1.1-12-0.7 I Data(month,day,year)
Address of authorized person (number and street oly,a and LP code)