HomeMy WebLinkAboutMortgage_Fullerton E:a_ . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County T sip
FOR DEDUCTION)FROM ASSESSED VALUATION • ' i,�1
■"• P. State Fortn 43709(R17/fi-09
Prescribed by Department of Loral Government Anne
File Mark _
INSTRUCTIONS: I
Form 1 ed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. �j{ Cpun Au i
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months �11`,
before March 31 of each year the deduction is sought. er
GI: • . • . • : • Sr
See reverse side for additional instructions and qualifications.
Ap.. .. • or contract buyer-see restrictions• re - --side) /
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Tatan•�-�s p :2Zit it V- C o- 6 o 16 9� -oar .J number 3 (�1�e /
Assessed 7 of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1.current year Mardi 1,cement year date of appal ati „ legal or equitable owner?
'_LL;{a:A ❑ 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 appican4 indicate below- Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(1C 6-1.1-7)
Name of mortgagee or contact seller •
Address of mortgagee or contract seller(n e ll city state.and ZIP code)
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,c%state,and ZIP code)
Does applicant own property in any other If yes,what county? - What Taring District? Has this deduction been requested on property
county in Indiana? anent yes ❑ No for aent year? ❑ yes
❑ No
COUNTY AUDROR .�
Deduction approved N the amount of.
_--
20 20 20 20 20
RuLLEreizsi S7� ,40,) c
(9/n..
Signature of County Auditor LC-5 V ear)
!
I I We certify under the penalty of perjury that the above and foregoing ire /3 -07Y/,S ant of Indiana and
owner I contract buyer of the afore -ntioned property on date applicatiot /
Sig • etas is rams)
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Fall r siden:cress a.....:•t(mamba and&beet sty, "e,and ZIP )
1' D tA 61 F 61. S ,-d- t£'16Y8
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) _