HomeMy WebLinkAboutMortgage_Flater STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
c' 7. FOR DEDUCTION FROM ASSESSED VALUATION
-J State Form 43709(Rl1/6-N)
•-,b Prescribed by Department of Local Government Finance
INSTRUCTIONS: i
b be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Fl,rrtx ed 171 i,,
Filing Dates: 1) Real Property 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
before March 31 of each year the deduction is sought - OR f;puntyRPRrder
See reverse/side for additional instructions and qualifications.
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AppGCant( nor xyd gtaub ^er on reverse � � (�fir� (�+ it '--
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1 date of application legal or equitable owner?
�� 0 Yes 0 No
If no,what's 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 appgeant,indicate below Is the property in question:Annually Assessed
&I) ❑Real Property ❑AnnuallyAssessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contact seller(number t
Name of assignee or other owner or holder of mar
Address of assignee(number and street.city,state .c[ i a
Does applicant own property in any other requested on property
county in Indiana?
-teL❑ Yes ❑ Nc a e
—❑
Yes ❑ No •
f9--i.Deduction approved hi the amount of B t lO 7 __ T)
20 20
° 20
Signature of Canty Auditor 1-800-322-3391 rY Year)
I/We certify under the penalty of perjury it Insurance and Risk Management for Local Governments iident of.Indiana and
owner/contract buyer of the aforementionr _ ,,..____..._...........
nature( (u name) , S. Date(month,day,year)
1ss�
to ' ant address of applicant(number and street city,state,and ZIP e)
I(r1A`Z. E N Io u Q SM. 41L olo
authorized by drily executed Power of Attorney or by IC r-1.1-1 -O.7 Date(month,day,year) - -
Address of authorized person (number and street oty state,and ZIP code)