HomeMy WebLinkAboutMortgage_Elpers ` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township Year
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-= i. FOR DEDUCTION FROM ASSESSED VALUATION FILE
State Form 43709(RU I6-09)
- Prescribed by Department of Local Government Finance File Mark
I r•
INSTRUCTIONS: Fo i-d with:
To be filed in person or by mail.
Filing Dates: I) Real Property Must be completed and dated in the calendar year for which the deduction is sought. C my ^'
Must be filed with the County Auditor or County Recorder of the county where the property is located / corder or before January 5 of the immediately succeeding calendar year. �1 t, •
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of thr3I.B--• k •
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) I'
•f 11 jai t t, Ke n J ^^ �(/J as-SO0-0 oZ.l b" Record nul I Page nu by
Taxing District II Key number l legal description dV (p' 6�4 I 1�O c
�O�I\-Aw. (\\vn�ers 0 c ossrr� 2. is+ q
Assessed value of real property as of I Mortgage/Contract ind_ e.dness unpaio as of Mortgage/Correct indebtedness unpaic as of le al or applicant the sole
A1 equitable owlet?
March year date of applirabon
zr� current Mh 1 current l,
ent year L�flroo 0 o Yes El No
\i�O\1 oa I{b,000 V
If no,what is his 1 her exact share of interest?
If owned with someone other than spouse,indicate with whom
Is the property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: Ill Real Properly ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Lag ence. RnrNY_
Address of mortgagee or contract seller(number and street,d:y,state,and ZIP code)
(3Ati, qth Sfree4 £Ldarado, IL 1oa9rU
Name of assignee or other owner or holder of mongage
Address of assignee(number and street,city,state,and ZIP code)
v
Does applicant own property in any other I If yes,what county? I what Taxing District? this deduction been requested on properly
for Yes El No
for current year?
I!
county in Indiana? ❑ Yes N
COUNTY AUDITOR
Deduction approved Li the amount of:
20_ 20_ 20
20_ I 20 .... .... I 20-- 20 .. ...
County Date(month,day,year)
Signature of County Auditor
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 filed.
Satur- •cane/s�ll cane r I oat,{month. y ye ),a// i /
Y
Full reside f ddress of applicant(nu. er and s�•eat,city,state.and ZIP code)
\or • . & PiNfacctnt 'Rota . \- i1. \r7r?1- I \P) Lin(E3q
Date(monm,day,year)
Person authorized by duty executed Power of A..omey or by IC 6-1.1-12-0.7
Address of authorized person (number and street,city state,and ZIP code)