HomeMy WebLinkAboutMortgage_Garrett (19) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counq� a s ,, Year
FOR DEDUCTION FROM ASSESSED VALUATION p 1 �l jp'
:. State Form 43709(R11/6-09) i
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: I - !
b be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located.
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought. El •un i`
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 I, 1'W-11f r rl'R• -ecorder
GIBSO. • • • • ?
See reverse side for additional instructions and qualifications. LAii-404—Applicant( err-see restdcfions on reverse side) Record Taxing District Key
(.G�- Idal�4�_n 4D3- DOD. 543 -f a 542 3
Assessed value d real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as Is the applicant the sole
March i,current year March 7,a t year date of application legal or equitable owner?
Li ITh ❑ Yes ❑ No
If rw,what is his/her end share of interest? ! if owned with someone other than spouse,indicate with 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(IC 6-l.1-7)
Name of mortgagee or contract seller r1 ` .
Address of mortgagee or contract seller(number and street city,state,a P code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and stree4 city,state,and L — -
Does applicant own property in any other If s this deduction been requested on properly
county in Indana? current year? ❑ Yes ❑ No
❑ Yes ❑ No Drawer NO U/
Card NO. yg(D�
Deduction approved in the amount of: YA '�`�
20 20 2 . • 3; 0 3? °i 20 20
I I r
Signature of County Auditor • County Date(month,day,year)
I 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 I contract buyer of the aforementioned property on date application is filed.
Sig own`e�furs name) Date(month,day,year)
W� �i
FiA ' ant address of i(number and street city state,and ZIP code) �J /�
Person authorized a oy dyW exef'�wrar�oftAtt«ney or by IC _,2�.7 ^ -1 2 b 7(/ Data(momh,day,year)
Address of authorized_person (number and street city.state,and ZIP code) •Olt/11•n`