HomeMy WebLinkAboutMortgage_Miles a.
. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun !R Qiy1{II I7:r
f ?•14 FOR DEDUCTION FROM ASSESSED VALUATION- ` �
State Form 43709(Rt t/6-09)
Presaibed by Department of Local Government Finance
INSTRUCTIONS:
F•. filed with' _
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. A e(
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought Lz sclir S anon
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)month I B SO N All Ugly
before March 31 of each year the deduction is sought - ty tc er
See reverse side for additional instructions and qualifications.
Applicant� 6064-' buyer- •/ on reverse site)2$Tvcontact
y •
Record number
/3a/escripfiap-
�O/ /—�� .20 13 Page
Li557
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract' ess unpaid as of Is the applicant the sole
March 1,anent year March 1,current year date of application legal or equitable owner?
On ❑ 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 applicant indicate below. Is property in question:Annuaily Assessed
r �y1/� Real Property ❑Annually Assessed
// �0/J �/rt-�� Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller //
Address of mortgagee or contract n a 1,city, te,a/M/Zy1�P code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,cdy,slate,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 current year?
❑ Yes ❑ No
COUNTY AUDI ^^
Deduction approved m the amount of: / p 1 / 3
Drawer NO l�/�`//�Ol/ ✓} .
20 20 20 20 _
Signature of County Auditor • Count Card NO. .......t•Cr.y...r•••t•
1/We certify under the penalty of perjury that the above and foregoing information a v„e e.ti u.. m w,..0..2 oH,..,e.,....a.w..vin..i...,.cad and
owner/contract buyer of the aforementioned property on date application is filed.
itowroh
AS name) Date(month,day.year)
Q . 7 n.4..2.e.0
X
Full resident address of (number and street city,state,and ZIP code) �r ' —
CF0q I / hesfnbrf SI. Francisco , IV 762 CSI
Person authorized by duly executed Power of Attorney or by IC 6-1.142-0.7 Date(month,day,year)
Address of authorized person (number and sheet,city,state.and ZIP code)