HomeMy WebLinkAboutMortgage_Paul (2) , ^. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION .
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. '\t.,:i . State Form 43709(R11/6-09)• FIT J E,a Prescribed by De part ment of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. DE .1 file 1.7r
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be fled with the County Auditor or County Recorder of the county where the property is located El County Auditor
on or before January 5 of the immediately succeeding calendar year. I I , !' c c unry Recorder
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the '����
county where the property is located during the twelve(12)months before March 31 of each yOtB$ON • • t - • • •
deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-we restrictions on reverse side)
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Taxing District Key er/legal description P iga n• rr. it O 2 Co issl� - _ 7il I / l /O
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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
March 1,current year March 1,current year date of application 1 p legal or r-equitable owner?
If no,what is his/her exact share of in' > // Oa6 SU 0 D T� ❑ No
ail - I/1-79 1/d D-Wfao y-oat/ If owned with someone other han spouse,indicate with whom
If name on record is different than that of applicant,Indicate belovr. Is the p in question:Annually Assessed
eal Property ❑Annually Assessed
N//me cf mortgagee or contra}}seller
Mobile Home(IC 6-1.1-7)
527O//mp.tC 1/4DLYli.- //at-7j".t Z Z L'
Address of mortgayyeepr contract seller(number and street,city,state,and ZIP code) /
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Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,sate,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been
county in Indiana? ^ requested on property
❑ Yes O __— or cu rent year?
❑ Yes go
Deduction approved COUNTY AUDROR �
pproved in the amount of:
20 20 20 20 20 20 20
Signature of Count'Auditor County I Date(month,day,year)
JL We certify under the penalty of perjury that the abo and foregoing joiction is true and correct and that the applicant is a resident of Indiana and
er l contract b r of the aforementioned property\:,i date applirat on is Ned.
5�\re,( • /s/u0 nam Date(mo day r)
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Fill resident ddress of a 'in number and street,city sat: and LP cod= I
i0/ Sp S-7777-3 CD .5- (-111/1-)f-ii/e-e f /7GG r
Person authorized 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,sate,and ZIP code)
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