HomeMy WebLinkAboutMortgage_Viton a f'• _ Ir STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County hi r I
1 FOR DEDUCTION FROM ASSESSED VALUATION {
State Form 43709(R71/6-09)
Prescribed by Department of Loral Government Finance
F - a
INSTRUCTIONS: 1
To be filed in person or mail with the Court Auditor or County Recorder of the county where the property Form filed with:
-
P by County N ty P Pent is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. , .Coy ty . ,•}.
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 - iL >�A'�fl?r•• •er
GIB•ON OU. II a II . r
See rev= e side for additional instructions'and qualifications.
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Assessed value at real pa:pe ty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applcant the sole
March 1,anent year March 1,current year date of application
or equitable owner?
/� � ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than dyouse.indicate with whom
If name on record is drferent than that of applicant.indicate Irby Is property in question:Annually Assessed
y[J Real Property ❑Annually
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seder Address of mortgagee or contras seder(n W40,x3
4 city,state.and ZIP code)
Name of assignee or other owner or holder of n I4 age
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 current year?
❑ Yes ❑ No
COUNTY r .__-. .... .�___
Deduction approved in the amount at ^
20 20 20 20 Drawer NO �/`J 20
Signature of County Auditor Card NO.
WO, Ca
1
I/We certify under the penalty of perjury that the above and foregoing inform - V f/ l.tN r t/`� of Indiana and
owner/contract buyer of a aforementioned property on date application is filed.
/ Signature((owtrers fu name) . I/// j ( /) _ Date(month,day.Year)
i Full rehident address of a t(number and street city,stale,end end ZIP code)
( 3 A) RThca
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of auJ.ni.cJ person (number and street city,eta and ZIP code) .