HomeMy WebLinkAboutMortgage_Chamberlain (5) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T ht
tFOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Presotbed by Department of Local Government Finance
Ftigt (3 I .
INSTRUCTIONS: _ 1
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property Form fled with:
Pe Y b ry / v cent(s located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. I' Coons.Au•i,•r
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months GI• ,�o'•jrrltl�� •er
before March 31 of each year the deduction is sought. - •$O n W t
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See reve -side for additional instructions and quua /�alificationass.. /] ,,,,,r /)
T.: •' Key•/per/legal d boon ' / R�prd number Page number
'at ��(/ ♦ , -n 07�/O/- 006. 7"S9- �0 00/3 7.57 -/
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,cement year date of applica' Q legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other(han spouse,indicate with whom
If name on record is different than that of applicant,indicate below: property in question:Annually Assessed
IS ;teal Property ❑Annually Assessed
TTTTTT```"` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller () fJ
Address of mortgagee or contact seller(number and street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage /
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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
minty in Indiana? El Yes ❑ No for current year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduobon approved in the amount oh
20 20 20 20 20 20 20
Signature of County Auditor Caur_.—If.- I rt�'��'�`j+^/�y'�
I/We certify under the penalty of perjury that the above and foregoing infonnn LN)' t` �n I LyN`/t; liana and
owner f contract buyer of the aforementioned property on date application is filed.
Sig ji i -(owner's tut)name) /3 - 45 7
1-.L.Sist Full resident address of a•• - I(number and strut aTy,state, 1 ZIP code)
x
I` /01 gw Mit ( .S7 ('Af0if0 14/
Person audnrized by duly executed Power of Attorney or by IC -1.1-12-01
I - -
Address of authazed person (number and street,city,sate,and ZIP code)