HomeMy WebLinkAboutMortgage_Ward (4) wr+. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r. psi_ FOR DEDUCTION FROM ASSESSED VAL �
Y ' P. State Form 43709(R71/6-09) ED
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: II II 7
T
with:
o be filed in person or by mad with the County Auditor or County Recorder of theg tylw2eri oropeny is located. Form fled
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 Properly t fife during the twelve(12)months
before March 31 of each year the deduction sought County Recorder
See reverse siidefor nalinstructionsandquer.ntions. G)BSON COUNTY AUDITOR
Ap1><oant(ownelbcpu��-,eyp mstt�ons 1 •side)
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Taxing ITG�V -1J —�`W L.O OIOO —CO I Record numffii Page 60`y
Assessed value of real property as of Mortgage(Contract"v debtedness unpaid as of Mortgage I Contract indebtedness unpaid as�off Is the ap opManlC t the sole
Manch 1,anent year March date o1 application legal a equitable owner?
OW ❑ Yes ❑ No
If no,what skis/tor exact share of interest?
( If owned with someone other than'pmHe,indicate with whom
If name on record is different than that of applca t,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually assessed
Montle Home(IC 5-1.1-7)
Name of mortgagee or contract seller E 6 /�
Address of mortgagee or contract seller(number and street,city state,sstajte,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 District? Has this deduction been requested on property
county in Indiana? r __—_ __ _ - -- — for current year? ❑ Yes
�AFPI Ro1'..`^'I P ❑ No
SI Goy -) A OR
Deduction approved In thee: Q J
I 1 .3/-laShc I {� 20 20 20
Signanae f .ry ad' `/�� ' V`-" I t:aunry Date(month,day.Year)
I/W 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.
Sii manna rte¢fiA/r j Date(month,day,year)
Full resident address of applicant(number and street ci17;state,and ZIP code) 14
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Person authorized by duty 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) .