HomeMy WebLinkAboutMortgage_Reising (6) �:� . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
L<e„� FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Presoibed by Department of Local Government Finance
File k
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is I ted.I F
Filing Dates: 1) Real Property:Must tile during the year for which the deduction is sought. unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months 1�
before March 31 of each year the deduction is sought OCT 1 LO 1 3 County Recorder
See reverse side for additional instructions and•ualifications.
App&Bnt( or contract buyer-see restrictions, - side)
Va s2�Alr . ., t,ItibLJ/RauGFdNFICAUCI$®Rtrnber
�Taxing Oisuict number/legal description ``
`f142- � a (o-►-1 -a.5-. on)) tif� oaI ad/ .3 348'60
Assessed value of teal as of Mort gage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the nt the sole
Mach 1,anent year March 1,current year date of appGcuticn legal or r equitable owner?
1/4_5-rood • ❑ 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 rend is different than that of applicant,Indicate below. )I,s_th�e property in question:Annually Assessed
❑1Real Property ❑Annually Assessed
T Mobile Home(IC 6-1.1-7)
Name of mortgagee or con er
Address of mortgagee or contact seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,coy,state,and ZIP code) .
Does a scant awn in any other If 1 �
PW property y yes.what county? Drawer it\r`c 1• \0 / 1 tied on property
county in Indiana? ❑ No 3 e�
❑ Yes / n Yes ❑ No
COUNTY Card NO.
Deduction approved in the amount of:
20 20 20 20 20 20 20
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.
'nature(owners name) Date(month,day,year)
It' /c — /s -r3
Full resident address apprxartt(numbers street city,state,and LP code)
- 70YVit., 9U el, S 6 I✓ Gp3U /LL /_ iv c-x7663
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 rode)
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