HomeMy WebLinkAboutMortgage_Stelling STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County T p
a� ; FOR DEDUCTION FROM ASSESSED VALUATION gy��ynp}n I 1
�•,• y'l State Fonn 43709(R11/0-09) . g �J �� ,��
"-4-,7,_.:7: Presmbed by Department of Local Government Finance
INSTRUCTIONS: FlI A. I
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 with:
Filing Dates: t) Real Property:Must file during the year for which the deduction is sought fl Coun y A_�-
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(f 2)months tom";
before March 31 of each year the deduction is sought - G I:S•~ • %r
C•,JI, Y AUDIT• ;
See reverse side for additional instructions and qualifications.
Appfrant( or trartipuyer-see ' .ors on verse side)
Taxing District_ number/legal description Record number Page number
P a( - U -6� • LI63 - oil I . lal doV Ftif
Assessed value of real property as of Mortgage/Contrail indebtedness unpaid as of Mortgage I indebtedness unpaid as of Is the appfirant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
-1 n?:3 es ❑ No
Ili no,what Is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of appkc ant,indicate below Is the property in question:Annually Assessed
bal Property ❑1 Assesed
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet,city,state,a IP code) .
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,rtty.state,and ZIP code)
Does applicant own property in any other If / �
county in Indiana? Y pp.-,,�� Yes.what county? • What Taxing District? / �Il O 1 )
❑ Yes ❑YNo V;••'' '••••••••
•
COUNTY AUDITOR �Ya�`C` '`O 9'•� pit
Deduction approved in the amount of: �,.t•'
20 20 20 20 20 Car a rO• ••• •••�I" _,r /
1al�p
Signature of County Auditor County I Date(month,day,year)
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 (o rs boll nil )r c `, Date(month,day.year)
resident y3 of applicant t(num6er and sbeev`—r. slate,and7�P�tle) C i,1.,,, , `^
yt/�.O(\tu2 (y`�` lhlxa V✓■ � �-f t)i,Yi, ill
Person authorized by duty executed Power of Attorney or by IC 6-t.1-12-0.7 Date(=nth,day.year)
Address of authorized person (number and sheet OA state.and ZIP code) _