HomeMy WebLinkAboutMortgage_Sluder w- . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS - County F Ii7I3 113
bf` 2 FOR DEDUCTION FROM ASSESSED VALUATION
- .,„, SIa(a Form 43709(R71 1 6-09)
-`f-- Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: 0 r I 1
Form +ed with: •
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 file during the year for which the deduction is sought Cc ty r.
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months r
before March 31 of each year the deduction is sought I rd�
GIB'• • . • . : • •
See reverse side for additional instructions and qualifications. v,//JQ/
w b /r ea -- •••:• on re me side - /JL�/�^'' /, n/////7,r t'
• / � d tin d --.. .number Page number 7 TT _as ss, - Ii , 3- .419411. I — — A O/3 70
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,arms year March 1,current year date of application nara legal or equitable owner?
❑ Yes ❑ No
lino,what is his/her exact share of interest? If owned with someone other n spouse,indicate wnt whom
If name on record is different than that of applicant'indicate below: Is property in question Annually Assessed
Real Property ❑Annually Assessed
illidie_-■ Motile Forte QC 61.1-7)
Name of mxtgagee a cOntraU setlu +/{''/n/
Address of mortgagee or contract seller(n and sree[ury state, ZIP
Name of assignee or other owner or harder of mortgage
Address of assignee(number and sleet city,slate,and ZIP code) /��/.
Does applicant own property in any other If yes,what county? - xn�i/'What Taring District? Has this deduction been requested on property
county in Indiana? El Yes ❑ No current year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of -- _
20 20 20 20
(91.__
Signature of County Auditor • County l'1\\'C I' NO C9
I I We certify under Ne penalty of perjury that Ne above and foregoing information is to Card 11 VC. 9-°('
owner I contract buyer of the aforementioned property on date application is filed.
(owners hAn `�
/[�' Mtn.,
1
Full ent apprranl(number and city data,and rude) D (�
0(� .acil�t.cvw-. ( ctw.vw it Fyn- ) Li7 to 6 S
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 sloe;dry,state,and ZIP code)