HomeMy WebLinkAboutMortgage_Elaman a3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County T ip ar
FOR DEDUCTION FROM ASSESSED VALUATION
1' State Form 43709(RD/6-09)
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Prescribed by Department of Local Government Finance
INSTRUCTIONS: Fdeitu}ifrk9 2013
To be filed in person or mail with the County Auditor or County Recorder of the coup where the property Form filed with:
Pe by h' N N P PeriY is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. III, Co.'41044
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
IBS •
See reverse side for additional instructions and qualifications.
Mpr�ant,(' orf�b/yya� seems//y�n�/I .re{ve/s�sy(�p/o�n /I 7Q�/'"/, (� may, p
To Y' .�J(i%//_.�ic (//CL ' �//afr//v — O J -00�/0 /—Cam-'/ Record Peg O ��/{
Assessed value of real l//asass of / / the
Marts 1,onenl year property March Mortgage Contract unpaid as of Mortgage 1 Contract Indebtedness unpaid as of Is the apf>�t the owner?
year date of application c�z7i� legal or equitable owneR
/d(/ �U ❑ 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 petty in question:Annually Assessed
/ Mobile
Real Property ❑Annually Assessed 1.1-7)
Name of mortgagee or contract seller
/. iJ ' • 4y6` F�
Address of mortgagee or contract seller(num•-r and street dry,state,and ZIP code) '
if . .
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,ml:state,and ZIP code)
Dees applicant own property in any other If yes,what county? • What Taxint, y
Monty in Indiana? /
❑ Yes 0 N / l- Ali No
COUNTY AUDITOR vv 'Y
Deduction approved In the annum of
20 20 20 20 20 20 20
Signature of Canty 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
owner I contract buyer of the aforementioned property on date application is filed.
re(own bill nae) /' 1 Date(month,day,year)
u !leant resident address (number and L city,state,and ZIP e)
I&'T) S . m C'LLuAcs: ap°.isc 4.e. Lin C)
Person authorized by duly executed Power'of Attorney or by IC 6-1.1-111-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)