HomeMy WebLinkAboutMortgage_Mitchem .M1 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Fl E E' er\'$/)
FOR DEDUCTION FROM ASSESSED VALUATION
.-s T2.,1 state Fonn 43709(R1116-9)
Presaibed by Department of Local Government Finance
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INSTRUCTIONS: Fit
filed with
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 I%; Cou J A .i.
2)Mobile/Manufactured Homes not ac-PSsed as Real Property Must file during the twelve(12)months r . ii lln •er before March 3/of each year the deduction issought - GI:SO' COON AUDITO '
See reverse side for additional instructions and qualifications. •
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apparant the sole
March 1,current year March 1,anent year date of '/aPpfca ^040 ❑ ❑
'/7// 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 property in question:Annually Assessed
Real Property ❑Annually Assessed
. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seder(number and et,cay.state,and ZIP code) //^��
Name of assignee or other owner or holder of mortgage . jeP / /// / 2
Address of assignee(number and street,city,state,and ZIP code) `/(/// /(,(—lX// O
Does applicant own property in any other If yes,what county? - What Taring 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 of
20 20 20 20 20 20 20
Signature of County Auditor 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.
hire ants 7W •.:) Date(month,day,year)
Full residenn of n • •-r and• 4 city, to rd ZIP at Aizter7700 t4 2e)
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 state,and ZIP code) .