HomeMy WebLinkAboutMortgage_Ross (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C _Townshe Year
FOR DEDUCTION FROM ASSESSED VALUATION qy�J utl9 1,'
1' State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: - D rNed.:
To be filed 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 Me during the year for which the deduction is sought. I . • n • •itor•2) Mobile/Manufactured Homes not assessed as Real Property Must tile during the twelve(12)months IA, •&�j& Ai my Recorder
before March 31 of each year the deduction is sought. GIBBON •I • • _ t e
See reverse side for additional instructions and qualifications.
p6a7199r or b r-see on reverse side)iiit
p - i. •- I legal description number P ge number
�` Gcc ��/3� o�eb-rte. �i9- � I. /3 , ,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact hdebtedness unpaid as of Is the apperant the sole
March 1,canal year March 1,current year date of ap legal or equitable owner?
❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone othlthan sparse;indicate with whom
If name on rend is different than that of applicant.indicate below Is property in question:Annually Assessed
Real Property ❑Annually Assessed
£ 4aJPI Moble Home(IC 6-1.1-7)
daee or ler � Qi� 1
Address of mortgagee or contract seller(nummr aandd ssoeet,city.sstaa ZIP code)
Name of assignee or other owner or holder of mortgage �}
Address of assignee(number and street.city,state.and ZIP code)y/�/ se /2' I o. 7 ^�f�
--••••wrty in any other I If yes,wha [7 county? What Taxing District? Has this deduction been requested on property
for current year? ❑ Yes ❑ No
Drawer NO IS .
COUNTY AUDITOR
Card No LP�?s
. . 20 20 20 20
;
Signature of County Auartor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and Nat the applicant is a resident of Indiana and
owner I con r of the aforementioned property on date application is filed. I
f/ y0r-,• :Cs me) Date(month,day,year)
,I\ ,[n
Full 4ent ed of applicant(number and street,ol4:state,a ZIgg code)
x/311/ /156 E ark/art, et by TA/ (1-764-0 I
Person authorized by duly executed Power of Attorney or by IC 6-1.1-1 7 - Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) I