HomeMy WebLinkAboutMortgage_Campbell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�; FOR DEDUCTION FROM ASSESSED VALUATION `�
-- - I- State Form 43709(R11/6-09) T pT,• V
Prescribed by Department of Local Government Finance IF I o �'y I)
3.J j,J File Mark
,STRUCTIONS:
robe filed in person or by mail with the County Auditor or County Recorder of the court;wbet1 t1it pRlaerty is located. Form Ned
Filing Dates: 1 Real Property:Must file during the .,c 1,,lo
lug ) Homes year for which the deduction is sought"- County Auditor
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 ilwilifio — County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or.?...b - -see •-, •.•. premise side)
�1fl�na COUNTY AUDITOR
• 1/
Tax• 'strict Key number/legal d ' • Record Page number
n.ck -/9-/r-IOC-ool. 1S/oil6 37/3
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,arrent year March 1,current year /� date of application legal or equitable owner?
37/lo/oo0 ❑ Yes ❑ No
If no,what is his I 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 the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(1C 6-1.1-7)
Name of mortgagee or contrail seller
Address of mortgagee or contract seller(number and street,city,sate,and ZI e) /
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? ❑ Yes ❑ No for wrrent year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at
20 A20 ,�/1 '20 20 20 20 20
lI-2 �4 i/11iN i e-- County sikloo Date(month,day( el __oa^.J
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!contract buyer of the aforementioned property on date application is filed.
Signature(owners(u9 name) -- Date(urine,day,year)
I , r
Fug .— tad. - of-.. t(nunlbera.. -t,any ZIP c
Person authorized by duty execute.]Power !Attorney or by IC 6-1. 12-0.7 Date(month,day,Year)
Address of authorized person (number and street city,sate,and ZIP code) .