HomeMy WebLinkAboutMortgage_Creek 6). STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
vr;: FOR DEDUCTION FROM ASSESSED VALUATION
" -, State Form 43709(R11/6-09) I
^�'—. Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
nA''��ppr� QQ Farm Ned with:
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where/vlelpmipctty tact.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. yy County Auditor .
2) Mobile/Manufactured Homes not assessed as Real Property Must file during twelve 2) Lf--Jt
before March 31 of each year the deduction is sought. - County Recorder
See reverse side for additional instructions and qualifications. C,,IRSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restricts on reverse e)
T District Key number/legal desolation Record number Page number
N-`r- - a(0-\\-t1-'f ao -oac.3 9 S-oaf ao <c iii
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Conrad indebtedness unpaid as of Is the applicant the sole
March 1,wren year March 1,current year ,^, \\ date of application legal or equitable owner?
boo ll ❑ Yes El No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record is different than that of applicant indicate below Is the property in question:Annually Assessed
KReal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee orIler
Address of mortgagee or contend seller(number and street,city.state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,state,and ZIP code) 1�/y/,fin
Does applicant own property in any other If yes,what county? Wt. /f)j /(.9. tpeltY
county in Indiana? ❑ Yes ❑ No \O••(((��� lllY 0 No
Di-a∎VCl /^`
Deduction approved in the amount of: COUNTY AUD O ,••.I �•L......
Con ti IS �J
20 20 20 20 20
Signature of County Auditor - 'County Date(month,day,year)
I 1 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 on date application is filed.
$ignaWre(O rs full name) '7O�/��-�•�� Date(month,day,year)
tW resident address of a nt(number sbcead0 t,dry,state�aide)
T 417 g,3. wW /5t CA ?z7 6> c
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 r \ Date(month,day,year)
Address of authorized person (number and street,city,state.and ZIP code) .