HomeMy WebLinkAboutMortgage_McGillem (12) 4 . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township [ Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(Ri1/6-09)
Prescribed by Department of local Government Finance
FILE1j)-
INSTRUCTIONS:
To be filed in person or mad with the County Auditor or County Recorder of the county where the property J ' L 5 Red 99 n
Pe by N which N P pent is located. ,rj--I yydailry
Filing Dates: 1) Real Property:Must file during the year for which tie deduction is sought. LJ Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12);To nths
before March 31 of each year the deduction is sought - . • my Recorder
See reverse side for additional instructions and qualifications. IRSnpI 'CO UN
Applicant(owner or contras buyer-see on reverse sire) COUNI Y AUDITOR
Ta istrict numtter I legal tlesaipti.- I Record number I Page numro.
��.�-C L�Y�
;..4, 0 7_... / ..4._ _ cr O 3 _ 00/. , G 7- 0 A.P --- /y� 7,
Assessed value of real proper y as of Mortgage/Contract indebtedness unpaid as of Mortgage/Cl �t pQJ`e K•.
Manse 1,current year March 1,current date of app6' ' D 1"aw Cr 1`O:•••"'
I000
-
If no,what is his/her exact share H e of interest? owned with some
Card NO. ........J.3`... .. ....
If name on record is afferent than that of applicant indicate below
Name of mortgagee or contract se'�r ' _ I 01-)
Address of mortgagee or contract seller(number and steel,nay,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Add 1 assignee(number end street,c%state,and ZIP code)
. PT SE 1 - 1 - 10 . 1 J-A- L -
Dces 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 AUDITOR
Deduction approved in the amount of
20 21) 20 20 20 20 20
Signature pf County Auditor_ ,r 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.
" Slgren+rg( name) c-LC� Date(month.day,}vac)
XFull resides ad of t(number and t,city,sta 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 state,and ZIP code)