HomeMy WebLinkAboutMortgage_White STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun !,1111 12 i�lit.
aF" : FOR DEDUCTION FROM ASSESSED VALUATION
t'•' State Form 43709(RD/6-09) ,
Pr saibed by Department of Local Government Finance
SE '%72013 -
INSTRUCTIONS: -
Form tiled with:
lb be Med 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 Me during the year for which the deduction is sought t_ir . %):,q)g(ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months.
before March31 of each year the deduction is sought. LoIB90N740 UNTWAVEMEOR
See reverse side for additional instructions and qualificatio .
AppOcant . . -r% b r- reverses e a Record number Taxing f / / /i Q% / 4y—C/O0f. 00e .0017 �U / P" / OlO
Assessed vatue of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,arrant year March 1.current year date of appGleOor) legal or equitable owner?
� C// ❑ Yes ❑ No
If no,what's his/her exact share of interest? If owned with someone oth4than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is property in question:Annually Assessed
Real Property ❑Annually Assessed
- Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller '/�j//��]////� J//�
Address of mortgagee or contract sale umber�/� arud-srreet city. ,and ZIP cede) .
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other I If yes,what county? . What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for anent year? ❑ Yes ❑ No
Deduction approved hi the annum of.
20 zo zo Drawer NO tp, 0 13 — 20
Signature of County Auditor •
1 l•]�.. ... lay,year)
Card NO. :r((J
I/We certify under the penalty of perjury that the above and fore. - sident of Indiana and
owner/contract buyer of the aforementioned property on date of
Sig ..,e-f•wners j.r I Date(month,day,year)
F c,rk ''t.Tes/s of (number and sheet city,state,and ZIP code
X l8/7 WEc cn�+ww/06i PL/KE PR/NCErON /N4/A-NF7 /f 76 70
Person authorized by duly 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) .