HomeMy WebLinkAboutMortgage_Carson (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
of s: FOR DEDUCTION FROM ASSESSED VALUATION
r tt State Form 43709(R11/6-09)
Prescribed by Department of Local Government France
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. I
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought ❑ County Dr
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 JULC .
[Caueiy,Reoorder
See reverse side for additional instructions and qualifications. LU 3
Apprcant • or contract buyer-see. reverse side) /nom ,, �,,� /1 ,/�/ /1 g�ele
7 '' 9 say' A / Key numberlle9ald bon C. IJUit/J-� ' Gil cX/d' r�/lir-7"rirYrµyq
O' 2li& - /3- /9 - acct -oo0. I F6 —00 1,---- rf�Q/3 CA
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contraa'vndebtedness unpaid as of Is the applicant the sole
March 1,aarent year March 1,anent year date of apprrotion legal or equitable owner?
4Cp Do O ❑ Yes ❑ No
If no,what is his/her exact sham of interest? f
ct 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
Motile Nome QC 6-I.1-7)
Name of mortgagee or contract seller ,
2 •L F c u
Address of mortgagee or contract seller(number and street,city,sa• , rid ZIP coda)
Name of assignee or other owner or holder of mortgage /�o/d /^�
PddreVssQ`oef—asV�v/gnee( /3 state, r/ b / /� ��
Does applicant corn property in any other If yes,what county? - What Taxing District? Has this deduction been requested on property
county in Indiana? I for current year?Yes ❑ No � ❑ Yes ❑ No
COUNTY AUDITOR Drawer ' _
Deduction appmvadinthe amount at NO....,,.
1.. ... _
20 20 20 20 2 Card NO. •Lgc�„•
Sy of County Auditor County _
I I/We certify send the penalty of pef)ury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract uyer of theaforementioned property on date application is filed.
Slgnatz(o s fu
r ) Date(moth,day,year) .
yy�n e t�
of applicant('nI�(m�bar and street a7y,state,and ZIP code) f/' T �7'
P.O 1 S. ¢ %I/ :s/tin 7�-7`r / �N P?iseo ..7 z.12<n L/
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 1 Date(month,day,year)
Address of authorized person (number and street,city,Stara.and ZIP code)