HomeMy WebLinkAboutMortgage_Jones (6) : STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CourIty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
1 z State Fonn 43709(RU 16-0g)
Presented by Department of Local Government Finance
Fl
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.
Porn t-1.3 2013
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. I County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months b
before March 31 of each year the deduction is sought - County et
See reverse • for additional N' structions and qualifications. OUMTY AUDITOR li
Appfippl re b r-f J �resmr 7 re •/ .e) '
•Ta( D.,,e Key ,a //L`-•. d--'• on / Record number Page number
f , y I - �� 1.<l /.J�.�. �2 �Jo3G l 557 /
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the asp/mnt the sole
March 1,armor year March 1,cement year date of appl I legal o�'tads O
cia// 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(afferent than that of appacant indicate below. .is the properly in question:Annually Assessed
Dy Real Property ❑Annually Assessed
• / \ I Mobile Home(IC 6-1.1-7)
•Name of mortgagee or contract seller cz:r1/45 _ _ -
1
\'
Address of mortgagee or contract seller(number and street,ray.state.and ZIP code) _ V } - _
Name of assignee or other owner or holder of mortgage , /
SIB J
Address of assignee(number and sheet city,state,and ZIP code) ('/�
Does applicant own property in any other If yes,what county? - What Tarim / l / I
county in Indiana? ❑ Yes
0 N
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
X Signature( Date(month,day.year)
A
Fug t of t(rfumbera street city,state,and ZIP code)
authorised 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 code)