HomeMy WebLinkAboutMortgage_Collins (10) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T Year
"` (;` FOR DEDUCTION FROM ASSESSED VALUATION �p .J
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Francs
Fi e
INSTRUCTIONS:
FEB I rk
Form Ned with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. • d 111 ! _:. Auditor
2)Mobr7e/Manufactured Homes not assessed as Real Property Must file during the twelve(12)mo • ay/mg
before March 31 of each year the deduction is sought G IBBON NCO NT se U County Recorder
See reverse side for additional instructions and qualifications.
Ap t(owner or contract buyer- on reverse side) . �/IAV'y� .
,y1,/1 � j17r�� / �7 /�( i
Teri 1�2t '_`_A r� pl JI //1 zoY - o0o._ ao 9 -o 8 do sL P 3r d legal desolation Record number
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtednesi unpaid as of Is the applicant the sole
March 1,curet year March 1,current year date of application legal w equitable owner?
y a1 00a ❑ Yes ❑ the
If no,what is his/her exact sham 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 the property in question:Annual)),Assessed
❑Real Property ❑NmuallyAssessed
I Mobile Home(IC 6-l.1-7)
Name of mortgagee or contract seller /fat /y _ _ _
Address of mortgagee or contract seller(number and street city state.and ZIP code) 7�
Name of assignee or other owrherwhaber of mortgage ) [y/,7� Dra{1'er 10.. /
Add of assignee(number and Scree city;state,and/ZIP / / / /L.r Card I NO
Does applicant 1p own property in any other If yes,what county? - What Taxing District? -
coUrthf ❑ Yes ❑ No
COUNTY AUDITOR '
Deduction approved in the annum of. •
20 20 20 20 20 I20 20
Signa�of County Auditors County Date(month,day,year)
II 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.
re(owne fu0 name) //��/'1�� Date(month,day,year)
�ut ent address of applicant(number and street ctn1 sate,end ZIP code)
(310 S f y corPn 51 . /3-;nu kn LZ (e 2 97 '2(1)
Person au[horned by duly executed 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) .