HomeMy WebLinkAboutMortgage_Wallace (4) Y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count g 7gwnst flear
S;,; FOR DEDUCTION FROM ASSESSED VALUATION 1 1
f ' State Form 43709(R11/609)
\—w;;:i Prescribed by Department of Local Government Finance I
erark
INSTRUCTIONS: I I I
Form Ned with.
To be fled in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought � •u Au •
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months ,, -girl� a
before March 31 of each - ..j,,r 1•' Recorder
year the deduction is sought. GIBSOMilo - • -See reverse side for additional ins • ns and qualifications.
gpp5rary�oxpter or tpnoact,,,T see ?Terse o•• r'.•/`/j / (f-_ Key bet/C/leg(/ description Page n
; / /.� �. QS�a16 17 07 2
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness.unpaid as of Is the apf nt the sole
March 1,current year March 1,current year date of ap�/ _ _ _I legal or equitable owner?
�.Cy.`y�1 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other Ulan spouse,indicate with whom
I
If name on record is dffesent than that of appfoant,indicate below. Is a property in question:Annually Assessed
Real Property El Annually Assessed
I Mobile Home(IC 6-1.1-7)
•
•
Name of mortgagee or contact seller .../� I
•
Address of mortgagee or contract seller(numbaland sheet,city,state,and ZIP code) I
Name of assignee or other owner or holder of mortgage
e 2 /l oP74G//mil
Address of assignee(number and sheet,city,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 current year? El No
I DI Yes
COUNTY AUDITOR I
Deduction approved in the amount of.
•20 20 20 20
_ 20 j 20
Signature of County Auditor •nay,year)
I CI
I/We certify under the penalty of perjury that the above and torega resident of Indiana and
owner I contrail buyer/ofothe aforementiorled property on date appli D 1 :111'C I' �r
(/%J�� �� "rte//" �����Z^r.l_`_ _`-' ''11 ..21� '-GUY.Year)
Fitt resid nt address of applicant(number and street,city; e,and ZIP code)I C`)I•U \t O
x /o7 /1/ /77, Al Nit- f O� //7 /!/-e'NL.rr .,-r- . 1
Person authorized by duly executed Pourer 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) .