HomeMy WebLinkAboutMortgage_Purdue (2) 04 . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County s p F
,l'�l FOR DEDUCTION FROM ASSESSED VALUATION �� � 1
State Form 43709(R11/6-09)
Prescribed by Department of local Government Finance
Filentc 11 2013
INSTRUCTIONS:
To be filed in person or mail with the County Auditor or County Recorder of the county where the property Foy Ned '
Pe by ty h ty P Pent is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. •./ '
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months ' %' yarn,i
before March 31 of each year the deduction is sought. G BS 60 •= :`Y ITC R
See reverse side for additional instructions and qualifications.
Ap rorcoNreU buyer see t !icba /sd
Taxing District AL0 ffJ{/
� �^ � 4,9_.„,„/ � ✓ � W ^o 9 i r P a /6m flu e
/Assessed vale of real property of Mortgag e/Cont indebtedness un paid as of Mortgage
/ConYact'vde ass unpaid as of Is the applicant the sole
March 1,current year March 1,arrest year date of application legal or equitable owner?
application/ El Yes ❑ No
If 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 applicant,indicate berme Is the property in question:Annually Assessed
❑Real Property ❑Annualy Assessed
• Mobile Home(IC 6-1.1-7)
Name of ee or contract sell• A IIIP
Address of mortgagee or contract seller(nu . •,state,and el ie)
Name of assignee or other owner or holder of mortgage
Qi1 Cted /c/ii Y6//- /a
Address of assignee(number and street,my,state,and ZIP code)
Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested on property
county in Indiana? El Yes ❑ No for aurent year?
❑ yes ❑ No
'AUDITOR
Deduction approved In the amount a ,-
20O 20 20 20
l �o
Signature o County Audit .-S v 1\s Cl ) my Date(month,day,year)
v v •••
I I We certify under tht �o• e.:.formation is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer C;ll d —..e application is filed.
Signature(owners full name) Date(Tamth,day,year
I ' r Co.o. rqk4..". _�..._ YO—�i— /3
Fue t addresa.df applent(number and street,cal,state,and ZIP code
S v3 4 - rLer-L, 34 . ocIr1A,JJ C;L� >v 4-Robe -
Person authorized by day executed Power of Attorney or by IC 6-1.1-12-0.7 1 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)