HomeMy WebLinkAboutMortgage_Fears (3) F...1 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION f, 11 , F Ili
State Form 43709(R11/6-09) F r
Prescribed by Department of Local Government Furors
File Mark
INSTRUC77ONS: • Iry. I -
R,be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. County udtor
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 ecorder
See reverse side for additional instructions and qualifications. GIBS I! . .
t{ tontraUlluyer-se ael.2 reverse side)
Taxing Disidct Key number/legal description Record number Page number
a%o-US-la-ioG oco / 8Sso l7 ao 13 4/05
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,and year March 1,current year date of application legal or equitable owner?
c28 030 ❑ Yes ❑ No
If no,what is his/her etad share of interest? If owned with someone other than spouse,indicate with whom
If name on record is(afferent than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
. Mobile Hone(IC 6-1.1-7)
Name of mortga9r r contract seller
A -0-9A- YIO
Addy ss of mortgagee or chnv`traci seller(number and street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,cram,and ZIP code)
Does applicant own property in any other "- I Has this deduction been requested on property
musty in Indiana? for current year?
❑ Yes ` �Q� B� �,t t) J ❑ Yes ❑ No
Deduction approved in the amount at ., 2 gek O cto
20_ 20 , //f�� • _ 20 20
signature rae of County Auditor / 1' eq OR; Date(month.day,year)
I/We certify under the penalty of pe 'and that the applicant is a resident of Indiana and
owner I contract buyer of the aforerr,
% lure(ovate lull name) I Date(month,day.year)
/S.
Full resident:'dress of applicant(number a
Person authorized by duly exeared Power c Date(month,day,year)
Address of authorized person (number and _ _ _ - -