HomeMy WebLinkAboutMortgage_Anderson (7) a STATEMENT OF MORTGAGE OR CONTRAINEi�FT N S County Township Year
i°a:;; FOR DEDUCTION FROM ASSESSED VALUATIOONN
' State Form 43709(R11/6- )
Prescribed by Department of Lccal Government Finance JAN 3 2014
File Mark
INSTRUCTIONS:
•To be filed in person or by mail with the County Auditor or County Recorder of the ..4 4 t -iyiT j:•-rty is located. Form Nod
Filing Dates: f) Real Property Must file during the year for which the deduction is nit 1
2) Mobile/Manufactured Homes not assessed as Real Propeft9$$Kf- � gvi 'PA'lW(12)m nths County Auditor
before March 31 of each year the deducton is sought - County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or.. buyer-see restrictions on —. sid-
Tap •D' , Zfi,Q,lliji Key nu Iiii/legal desZ 18_aO OdO-0 • RecorQ inter Page number
Assessed value of real property as of Mortgage/ ntraa indebtedness unpaid as of �J l0
March 1.curer Mortgage I Contract indebtedness unpaid as of le the egthtnt the n
year March 1,p t date of application legal are equitable owrme
El Yes El N No
If no,what is his I her exact share of interest? ) If owned with someone other than spouse,indicate with whom
If name on record is ddferent than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
- /�. r� 7� Motile Horne(IC 6-1.1-7)
Name of mortgagee or contract Seger („ L / '�Q w /1 l
Address of mortgagee or contract seller(number and street,city. and ZIP code) �`�//�\..•
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested on property
county in Indiana? CI Yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 '20 20
S\Alr QX7J YR Q. County Daa( 01 _03 -1Y,day,
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.
Signature(owners MI name) Date(month,day,year)
Full resident address of applicant(number and street,dl%state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street,city:sate.and ZIP code) .