HomeMy WebLinkAboutMortgage_Vanvliet (2) r.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
t' ' f- State Form 43709(R11/6-09) l
s'::
Prescribed by Department of local Government Finance
INSTRUCTIONS:
Foal 11 aN�ed with: +
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is lode 5 2 Fx11
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. LLJJ County Auditor
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 - my Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see reverse side) CIDSON COUNTY AUDITOR
• Ua�,> .-
Taxi istrict Key number/legal desaiption �j Record number Page number
/LC..vt,ct-i Uw.� �. - /a_/8 J-o3 -000 . 111 -v at 8 - /3 Yloo3
March 1, value uer year property as of MMortgage��nta�indebtedness unpaid as of Mortgage I Contact Indebbtedness unpaid as of Is or equitable the e sole date of application
If no,what is his/her exact share of interest? If owned with someote other Marl ❑ Yes ❑ No
spouse.indicate vrith whom
If name on record is different than that of applicant.indicate below- Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home QC 6-I.1-7)
Name of mortgagee or contract seller
El .r /
Address of mortgagee or contact setter(number and street city,state,and ZIP code) — - —T� //�•�/
Name of assignee or other owner or holder of mortgage V AO v��•( ✓r+ R �'` 2 i
SCUT
Address of assignee(number and street,oty,craft..and ZIP code)
55 0_4-at to 13- ylD05
Does applicant own property in any other If yes,what county? - Mat Taxing Distr
county in Indiana?
[7I yes 0 N
COUNTY AUDITOR
Deduction approved N the amount at.
20 20 20 20 20_ 20 20
Signatu of rg County AWimt County Date(mwvh,day,year)
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 - e aforementioned property on date application is filed.
CSigna,r—i,i; brg Data(mondr,day,year)
-k- u�resid nt address of applicant(number and street,city,state,and ZIP code)
X iI c Y.s Pro- S71 i3,-)cJ-ti/7/F 4^yCn
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)