HomeMy WebLinkAboutMortgage_Coomer (3) ! STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
c FOR DEDUCTION FROM ASSESSED VALUATION
t't State Form 43709(R71/6-09)
Prescribed by Department of local Government Finance
File Mark
INSTRUCTIONS: NO ! . ;,4T.IIT:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the pmpetty is located.
Filing Dates: 1) Real Property.Must Me during the year for which the deduction is sought • Co my Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - gully`„ my Recorder
See reverse side for additional instructions and qualifications. G I BSO N i a • - • • I --• _
Applicant(owner or contract buyer-see on reverse side)
Taxi/ntg District �Kay�l description Record number Page number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,ardent year March 1,current year date of application legal or equitable owner?
5 share t op 5b r�9 Yes El No
If no,what a his/her exact sha of interest? owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below. Istth,ee prro��'perty in question:Annually Assessed
n n ai Property ❑Annually Assessed
A 1.7-T)
Name of mortgagee or contract seller
tT c. 0
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �/�
Name of assignee or other owner or holder of mortgage Q.0 13
Address of assignee(number and street,dl%state,and ZIP code)
. 't a
Does applicant own property in any other If yes,what county? What Taring 1.71"U ,O' I�, /.�
county in Indiana? r�j-/]rv� dD.....00 No -
❑ Yes l o Lfic.CU
I COUNTY AUDITOR I-
i Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor • County Data(month,day,year)
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
comer/contract buyer of the aforementioned property on date application is filed.
Sign o rs MI name) Date(month,day,year)
fW !a— •(��.r �
resident address of appwarht(numberand t.dty,state,and ZIP code)
aCZO6S 6s—a E 'Met? t/cco Si- y76 erg
Person authorized by duly executed Power of Attorney or by IC 6-t-1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .