HomeMy WebLinkAboutMortgage_Neber (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
" mss;: FOR DEDUCTION FROM ASSESSED VALUATION
• e ' t; State Form 43709(R11/6.09)
-1'" Prescribed by Department of Local Government Finance
File Mark
F.INSTRUCTIONS: _a ,
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. 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 acvngsed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought 11L co= -=3`
3N r..a+1I:11,
See
T. :reverse side for additional instructions and qualifications. GI:
IN COUNTY AUDITOI
Goan •
a ! s0nT re .side)
401
/l lfo / . , �M I Page m cl
alf d� r� / -6* _W/ /5 o,2 I N /±D
...value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ edness unpaid as of Is the app t the sole
=rent 1,at year March 1,anent year data of appfcatnn t legal or equitable owner?
// 11.• ❑ Yes ❑ No
If no,what is his I her exact share of interest? I If owned with someone other than spouse,�i ndicate with whom
If name on record is afferent than that of applicant,indicate below. Is property in question:Annually Assessed
Real Property ❑Annually Assessed
. I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract surer(n and sit-rechy.sit—re staff. LP Le
1
Name of assignee or other owner or holder of mortgage • 6 �
Address of assignee(number and street,city.state.and ZIP code) �� /
I
Does applicant own property in any other If yes,what county? • What Taxing Distant? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for anent year?
I Yea ❑ Yes ❑ No
I
COUNTY AUDITOR
Deduction approved In the amount of. I
20_ I 20_ I 20 I. _20___ 20 20 20
Signature of County Auc �O /� unty I Date(month,day,year)•
I l We certify under Drawer NO J< xt is true and correct and that the applicant is a resident of Indiana and
owner/contract lot ' /I 1. I
r.l Signature(owner's fur a .. (� . I Date(month,day,year)
't-2ni r—�- � Card NO. ......(((...555-������"
t resident address of:
X
el r1` l 1J, s 1—IN1 1176, 701 .
Person authored by duly exeta. .____._ I Date(month,day year) _. .__.
Address of authorized person (number and sheet city state.and ZIP code)