HomeMy WebLinkAboutMortgage_Wallace (21) a.
:a_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun IC'y�t� J
r-f-fir FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R77/6-09) -
Prescobed by Department of Local Government Finance 1
File Varlc
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Farm 1!t� - •(
Filing Dates: 1 Real Properly:Must file during the m ' � PI'
trig ) p cry: g year for which the deduction is sought. I',•,.�. T,
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months G BS e--. Co e - D IT
before March 31 of each year the deduction is sought - • County Recorder
2
See reverse side for additional instnxGons/and/q/uaalliifircations.. ,y //� p�
MPa1 .fc r-� nY- AJ C�CJ�Q- J�c-1-1�(�i�-�- -Record
Tsang District °/ la 7 g 30.3- 00.5. an SL Q2l2 4o/3 P sato
Assessed value of real properly as of Mort gage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the apprcant the sole
March 1,anent year March 1,current year date of applcatdo legal or equitable owner?
❑ 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(Efferent than that of applicant,indicate below `I�Iss�the the in question:Annually Assessed
`
t eat Property ❑Annually Assessed
Motile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
-
Address of mortgagee or contract seller(numbecandstreet_ciry mm=M ZIP code)
In • What Taxing District? Has this deduction been requested on property
�0(3-'� 55� I
for current year ❑ Yes• El No
-I - . , a COUNTY AUDITOR
a 7� 9 .° I 20 20 20 20
v
County 7 Date(month,day,year)
I
egoing information is true and correct and that the applicant is a resident of Indiana and
application is filed.
I Date(month,day,year)
full ant address ott num and atree5 coy,state,` nd ZIP&ode)
I;- - FILL tI berry Pd rice on,. Li 16170
Person authorized by duly exeaned Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street oily,ate,and ZIP code)