HomeMy WebLinkAboutMortgage_Black (3) `,fps?=fit STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Townshi Y
.. FOR DEDUCTION FROM ASSESSED VALUATION
1/44..State Form 43709(R11/6-09)
��—i" 'A Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: •1••• I a
To be Ned in person or by mail with the County Auditor or County Recorder of the county where the property is located. Farm
Sing Dates: I) Real Property Must file during the year for which the deduction is sought Coun Audito
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months • County ,j
before March 31 of each year the deduction is sought CF. e,dnvitrf.rer
See reverse side far additional instructions and qualifications.
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Record number numbe/
Assessed
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness ;paid as of Is the applrant the sole
March 1,=vent year March 1.cement year date of aP• legal or equitable ownM
a i '„ ❑ Yes ❑ No
If no,what is his!her exact share of interest? If owned with someone•• •r• --•Z:7.--,indicate with whom
If name on record is different than that of applicant,indicate below- Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 8-1.1-7)
Name of mortgagee or contract seller eae/y ) i
Address of mortgagee or contract settler(number and street city,state,,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street my,state,and ZIP code) /T /e 4 /J Does applicant own property in any other If yes,what(couunnnty? , PWha ? Has this req ested on property
county in Indiana? arte
❑ Yes ❑ No I for N year? ❑ Yes
❑ No
COUNTY AUDITOR
Evans.. IIe. Teaci,„rs '
EP d: C• Li , 20 20 20_ 20
Drawer NO..01-D
Sgnt ,, County Date(month,day,year)
I I Card N O. JW 9 1(7/ foregoing information is true and correct and that the applicant is a resident of Indiana and
a 1O.or000•`c.f 'a application is filed.
r Sgnawn wners no meet Date(month,day,year)
Full resident address of applicant(number and street city,state,and ZIP code)
.2 04 d.E. AAd- St GA-rnicA 7.4 47000
Person authored 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,state,and ZIP code) .