HomeMy WebLinkAboutMortgage_Maddle �k_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county flyar FOR DEDUCTION FROM ASSESSED VALUATION-a- State Fonn 43709(R11/6-09) I
Prescribed by Department of Lod Government Finance 171
INS7RUC71ONS: F•+AWI 4 I
Form Ned with:
7o be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Flung Dates: 1) Real Property:Must file during the year for which the deduction is soughL
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months GIB •O I�I•
0 N T AU DIer S r
before March 37 of each year the deduction is sought
See reverse side for additional instructions and qualificatio .
Apogean*(• contract/uyer-see --•' on re ••• -•e)
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I� : // S . . a//iL 'i ��/�//
Tani al desaiptmn ,.,t c� Record number" Page number 002
4 •value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/ indebtedness unpaid as Is the applicant the sole
ir. 1,anent year March 1,current year date of a legal or equitable owner?
dOCI ❑ Yes ❑ 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 different than that of applicant indicate below. Is property in question:Annually Assessed
Is
Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contract sego a n
Address of mortgagee or contract mber and sheet city slate./,aa
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street eery,state,and 2-7-- - -
Does applicant own property in any other II D 1 a Ivor NO. O/ Has this deduchon been requested on property
aunty in Indiana? ❑ Yes ❑ No _ ••.•.•• ..••• scut ❑ Yes ❑ No
Card NO. •...
D
•
eduction approved in the amount of ^'.....
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 I contract buyer of the aforementioned property an date application is filed.
�J Date(moan,day,year) c�-
Signature .�k� fiine �" /1 1 4/2 a//
F ent /of applicant(number and street'ary,state,and ZIP code)
XPerson authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of autorized person (number and sheet city,sate,and ZIP code) -