HomeMy WebLinkAboutMortgage_Norris . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year .
FOR DEDUCTION FROM ASSESSED VALUATION T
State Form 43709(R11/6-09)
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Presoibed by Department of Local Government Finance
File Mark
INSTRUCTIONS: )��
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is Iocatetif1.0 I F Atit
Rig Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ awn Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)month
before March 31 of each year the deduction is sought ' I�til County Recorder
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See reverse side for additional instructions and qualifications. rIRSON COUN
,�A(pll t(owner or contract buyer-)see resui 'erns n reverse side) �t q number
/ efOv1,4-- 014 legal description`f - 3 0 a -0°0. / Ito-0 d-0 3 Page
leg / 3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid of Is the applicant the sole
Marts 1,anent year Mardi 1,cement year date of appruation legal or equitable owner?
3o .�. v ❑ Yes ❑ No
If no,what is his l her exact share of interest? If owned with a other than spouse,indicate with whom
. If name on record is different than that of applicant,indicate below: �� J-00/IT /'A )
Name of mortgagee a contract seller 5.3 HFF
Address of mortgagee a contract seller(numhpr and street,city,state,and ZIP code) -��3
Name of assignee or other owner or holder of mortgage R--ltr ado ' •
Address of a4-C.(number and street,ray,state,and L,code)
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Does applicant owwn`•propertyyy-iinnn'an�'y other If yes,what county? - What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for anent yeah ❑ Yes ❑ No
COUNTY AUDITOR '
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sigru its • County Date(month,day.year)
I/We certify under the penahy of a above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature "ees Mil name) Date(month,day,year)
y coFull resident address of LippGnt(number and street,city,state,and ZIP code)
7O1 d, /mar, 51, f rr q7, 4'
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) •