HomeMy WebLinkAboutMortgage_Atkins (3) A.
� -. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County , Township Year
- FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R71/6-09) I
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: .,,It�µf,,,,p t+
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form) l vast 6 -2013
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 - r
1 = .x
See reverse side for additional instructions and qua lifications. GIB,III N COUNTY AUDITOR
Applicant(•0 contract buyer-see on re a side)
nn desaithina number i IQ 3 -- di- .600 - Uoo. a39- oi all/ )/3 AAssessed
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
March 1,awed year Mardi 1,current year date of apples legal or equitable owner?
` ❑ 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,ordinate below. Is property in question:Annually Assessed
.
Real Property ❑Anally Assessed
nu
Mobile Home(IC 61.1-7)
-
Name of mortgagee or contract seller /> e / e j '
Address of mortgagee or contract seller(number)reend street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,ray,state,and ZIP cede)
Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ ❑ No
Yes ❑ Yes ❑ No
Deduc 4 J KT j5, O4m o d&4&r COUNTY AUDITOR
/J_OS jJ 20 20 20 20
Signa .County Date(month,day,year)
I/ oregoing information is true and correct and that the applicant is a resident of Indiana and
owner r c n ...,—,_. -._ a application is filed.
1 rre(owners full name) ec — Date(month,day,year)
Full resident address of applicant(number and street,city,state,and 21 code)
Nb /06 /0 r 9.10c aCC% r c* 1:41 V-2 C( �
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 ) Date(month,day,year)
Address of aufr 1zed person (number and sheet,ctly,state,and ZIP code) •