HomeMy WebLinkAboutMortgage_Powell (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'� .��. FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/609)
Prescribed by Department of Lod Government Finance
File Mark
INSTRUCTIONS:
Form filed with
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
FrTmg Dates: 1) Real Property.Must file during the year for which the deduction is sought. ❑
2)Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)months County Auditor
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(over;or contract bar see triads on reverse • e) FILE i,'
Taxing D' Key numberI legal d coo" JAN 3 0943 Pae�
� a� )y-IA—ID -oot.a3.sno 5
Assessed property as of Abrnage/Contact indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the app2cant the sole
March 1. March 1 annnd/Y{��n �c7rf� date of appfrcaaon J//1[� >.. or equitable owner?
t `ab_I 1Vp� x,401) .104 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with son e°13 i(sppusa ) •f��'.W4hthpm R
If name on record is different than that of apparant,hdicete below Is the property in question:ll Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 3
Address of mortgagee or contract seller(member and street. I and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street ray,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? for current yea
❑ year?Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount at
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,year)
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
Amer/contract buyer of the ewer,ientioned property on date application is filed.
Signature(owner's furl name10 Da el(nonm.day.•year
of applicant(number and street city,state._ •ZIP code)
_ 660
t•�f�I�l'��^^�i �`� t • /r, ►� _ art v��
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12 4 g I , ` . \ � Date(month,day,year)
Address of autha ized person (number and street city,state,and ZIP code) g I�\1 l_.TD\