HomeMy WebLinkAboutMortgage_McKannan (3) dYra4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;e FOR DEDUCTION FROM ASSESSED VALUATION M
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. JAN 1 I Fgy{+,fed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. [UU� County Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is loc ed
on or before January 5 of the immediately succeeding calendar year. , , i' i. 7 •unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Count frCts . r 7',,?;;
county where the property is located during the twelve(12)months before March 31 o eac77ff --raeUN�-�,gUDITO
deduction is sought ( AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
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Taxing District Key number/legal description Recor number Page number
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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,current year March 1,current year date of application legal or equitable owner?
IS 1 (q fit t2OD fl Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone her than spouse,indicate with whom
If name on record is different than that of applicant,indicate below-. Is the property in question:Annually Assessed
0 Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
N me of mortgagee or contract seller
S \orb N10- c e dl�la Re(`-�'�\ofS N\or-toyage
Address mortgagee or contract seae nu . er and street.city,state,and i4P code) I
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Name of assignee or other owner or hold of mortgage
Address of assignee(number and street,city,state, 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 year? ❑ Yes ❑ No
Yeso
COUNTY AUDITOR
Deduction approved in the amount of:
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
owner!contract buyer of the aforementioned property on date application is tiled.
'attire wnees lull name) 7) �/�� /i�l/r ,n yl Qete(monJr.Qay,yedr
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Full resident address of applicant(number and street,city,state,and ZIP code)
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 street,city,state,and ZIP code)