HomeMy WebLinkAboutMortgage_Williams (20) •
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County �e�h p�
4.
-l9 FOR DEDUCTION FROM ASSESSED VALUATION Fit p t Iii
:-r State Form 43709(R1116-09) g .gJ
• +r..::
Prescribed by Department of Loral Government Finance
File G .2 9 2013
INSTRUCTIONS: M J
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form tiled
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought ❑ i.unty •-v
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months `� .7jg1)��,
before March 31 of each year the deduction is sought GI J.r�'��'•`: a
UDI—OR
See reverse side for additional instructions and qualifications.
Ap• (owner or contact buyer-see on rave - e) • •
1, Sri2 )c00a-n.<0 /i-/d.�/
T.0Z,.. ben/legend con Record number P number
/ �� `°"ia-o -/00-)O/4\aj -oat /...4 a
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness paid as of Is the applicant the sale
March 1,came year March 1,current year date of app ea' D legal or equitade 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 different than that of apparant,indicate below Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller {y'/—
Address of mortgagee or contract seller(number a t c ,state,aM ZIP cod /ICS
Name of assignee or other owner or holder of mortgage
Address of assignee(number end 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? for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDrTOR
Deduction approved in the anaunt of.
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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 .ate application is filed.
mane(owo/s lull name). ° 9' - Date(mot,day,year)
I , . .
a F resi rent add a.. •, t(n. and y-r.city,state,and ZIP code)
l` s 9b1/45 /muted Po J�7.
Person autho' duly executed Power of eY or IC 621.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city state,and ZIP code)