HomeMy WebLinkAboutMortgage_Caudill 4 �., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
C`y A State Form 43709(R11/6-09) I L
y
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the F Ned whit
wmPertyB 3
Ping Dates: 1) Real Properi7r.Must file during the year for which the deduction is sought County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months i
before March 31 of each year the deduction is sought - a i . , fl County Recorder
See reverse side for additional instructions and qualifications. eC ��
�� GlBSnfv CnufA1mm�CDITOR
Applicant contract buyer see t-ft a reverse side) �JCZ
Taxing District /!°f/ Key number/legal description 3 Record number Page number
2 & - 17-o/- L1Ot/ cacao. 3 s5 ).-o I coo ! g359
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appgrant the sole
March 1,current year March 1,cement year date of application legal or equitable owner?
a c o Q v i ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than space.indicate with whom
If name on rend is different than that of apogean,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually ally Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller i . -- _,
Address of mortgagee or contract seller(number and city,state,and ZIP code) _.
Drawer NO gar"
l
Name of assignee or other owner or holder of mortgage
Add a (number and street.rdy,state.and ZIP ) Card t I7O.
Q-ta_ ii Pr//2. ,T
Does applicant own property in any other If yes,what county? - What Taxing Dist/id
county in Indiana? ❑ yes 0 No
COUNTY AUDITOR
Deduction approved in the amount at
20 20 20 20 20 120 20
tin_nanm y Cesar - 1 County I Date(month,day,year)
I I We certify under the penatry�yof{pemrjury that the above 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(owner's lull name)12 I Date(math,day,year)
( C;14 rr
LAC address of applicant( r and street.a y,state,and ZIP code)
16gn/. -1—/d) rt_p Sr 0wenrt/ /Lie Zn/ Y26 S
Person authorized by duty executed Power of Aaorney or by IC 6-t.1-12-0.7 ( Date(month,day,year)
Address of authorized person (number and sheet dijr,state,and ZIP code)
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