HomeMy WebLinkAboutMortgage_Rexing 0- f
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION _ _ _
State Fonn 43709(R11/6-09)
Presoibed by Department of Local Government Finance
INSTRUCTIONS: '�1��) r
•To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Farm
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought Oeupgv Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months NH I 29 I J
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or Irv.buyer-sea reshcdons on re side) I
¢_ �
indebtedness unpaid as of Mortgage/Contract indebtedness'unpaid as of Is the appirant the sole
Marts 1.arrterit year March 1 Wrrent year date of aPPfiration I legal or equitable
111 .(VX) ((��/ Yes No
If no,what is his I her exact share of interest? r if owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Home(IC 61.1-7) i
Name of mortgagee or contract seller S 6
Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) I
Does applicant own property in any other If yes.what county? - _ _ I What Toy-,rt• •- --—- —`-- 4?Auction been requested on property
county in Indiana? ❑ No - P y , year? ❑ yes ❑ No
❑ Yes QgS°6 ,�
I 4% I-
Deduction approved in the amount of 4 t`Q8 boo cA
20 20 20 o U/3'z 3 i - 20
I I
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/contract buyer of the aforementioned property on date application is filed.
(owne r full rime) / -- / // Date(month,day,year)
Full ent address of applicant(number and street city state,aannddZIIP code))
Person authored by duly executed Power of Atomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,Gib;state,and ZIP code)
I