HomeMy WebLinkAboutMortgage_Nurrenbern (4) a,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County hip l
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'' FOR DEDUCTION FROM ASSESSED VALUATION iI`
!" ti State Form 43709(R11/e-09)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: as I
with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form filed
Filing Dates: f) Real Property:Must file during the year for which the deduction is sought 27 Coe,
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months dy "4
before March 31 of each g ( ) U N�S(A A er
year the deduction GI:1O` OUN AUDITOR
See reverse side for additional instructions and qualifications.
.... orcontraab -see . ' ' on reverse side)A
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Assessed value ofre real/`pproperty as of Mortgage 1 Contact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
Marsh 1,ancient year March 1,cement year date of cep no er?n legal or equitable own
5 .°7,e ❑ 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 efferent than that of applicant.Indicate below xIs the property in question:Annually Assessed
eat Property ❑Annually Assessed
/ ` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller f./`fin
Address of mortgagee or contract seller r and street,city, te,and ZIP code)
Name of assignee o offer owner or holder of mortgage
YET �� 075---,9 -/0 , 9//l
Address of assignee(number and street,city:state,and ZIP code)
Dees 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?
❑ No
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County 1 1 �/'y'y�)
I/We certify under the penalty of perjury that the above and foregoing information is true U GG✓V(Q� J
owner/contract buyer of the aforementioned property on date application is filed. `0 L.
SIg t (owners fuay: J
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Eon -.•ent uld,caa• . .Sl number and street city,state,and ZIP code) /3 .. I oI q
S�ar. e 3sys Y rt<r(_, /N V7rrY99 . I
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 -
Address of authorized person (number and street,city,state,and ZIP code) .
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