HomeMy WebLinkAboutMortgage_Wilder STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f' FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Presaibed by Department of Loral Government Fiance
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form coed with.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. ❑ 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 - ❑ County Recorder
See reverse side for additional instructions and qualifications.
ApPGrant( orconbact buyer�e�restrrJgns on reverse side) W 1 -
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Assessed value areal p as of Mortgage/Contract indebtedness unpaid as of Mortgage l Contract indebtedness unpaid as of Is the applicant the sole
Mann 1,wawa year Match 1,anent year op n legal or o Yes owner?
If no,what is his/her exact share of interest? ff 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 ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5/3
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 If yes,what county? - What Taxing District? Has this deduction been requested on property
county in Indiana? Yes ❑ No for anent year?
❑ Yes ❑ No
COUNTY AUDITOR '.
Deduction 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.
S (owners ri name) ,, , Date(month,day,year)
Full resident address ppfi \c ant(number and street city,state,and ZIP code)
Person authorized by duty 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,stale,and ZIP code)