HomeMy WebLinkAboutMortgage_Hopper (2) t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
12 State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
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 fled with:
Filing Dates: i) Real Property Must file during the year for which the deduction is sought 'FCEln1y Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(1 n V iiMirflpY,
before March 31 of each year the deduction is sought. - ty Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or tract buyer-see restrictions on side) 9f43a .&_ JUN 2 2013
Taxing District , 0 Key number
-0g-66/ 0 0!9• 2 1L7-( l Q n/Remrd n bar a number
Assessed value of real properly as a Mortgage/Contrail indebtedness unpaid as of Mortgage/Contract� s�fy')er�wry L.- t the sole
March 1,anent year Marts 1,cartent year datagftay/pugaym reTj3i• •u-de amen
^JI)r� U �� ❑ yes ❑ No
If no,what is his/her exact sham 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 question:Mortally Assessed
❑Real Property ❑ArmuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or tract seller AleLeYa
Address of mortgagee or contract seller(number 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 Dist/ --]
county in Indiana?
❑ Yes ❑ No K
COUNTY AUDITOR d " —
Deduction approved in the amount of: -1 —
20 20 20 20 'y}`It/ Ply- -
Signature of County Auditor • County �O'6-3359 —
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
owner/contract buyer of the aforementioned property on date application is filed.
na• - hra name) Date(month.day,year)
�re
F. -i t address of applicant(number and sDe state,and ZIP code)
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,stare.and ZIP code) .