HomeMy WebLinkAboutMortgage_Will (6) a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r FOR DEDUCTION FROM ASSESSED VALUATION
Stain Form 43709(R11/G09)
-; )
Prescribed by Department of Lecal Government Finance
';alai
INSTRUCTIONS: - ' :
Imod �.
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is to tied.
Filing Dates: t) 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 ACo
before March 31 of each year the deduction is sought - APR 1 unty Recorder
See reverse side for additional instructions and qualifications. ///```
Appacant(awror or cono�Q buyer-see re Ttions on reverse s Q(` .�j
ra • Disvrct ^�'f\ 04\xl J, '- CpUN7Y AUD170R Ica Key number 19 desaiption q37-Uo5 GIF35 f m i� Pi5ST5
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Conrad indebtedness unpaid as of fs the appacan the sole
Mardi 1,arrerd year March 1,anent 5 s date of appficadan legal or equitable owner?
0 Yes ❑ No
If no,what is his/her exact share of interest? i if owned with someone other than spouse,indicate with whom
If name on rend is different than that of applicant-indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
__. Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street, T aol ,.....
Dra\YCl- 1O.....•
Name of assignee or other owner or holder of mortgage _33 - -
Address of assignee(number and street ray.state,and ZIP c
Card NO. ............
Does applicant own property in any other If yes, this deduction been requested on property
county in Indiana? ❑ Yes ❑ No I for current year? ❑ Yes
❑ No
COUNTY AUDITOR
Deduction approved In the amount of
20 20 20 20 20 20 20
na County Auditor - County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Sg irernaS Date(month,day,year)
Full',islets address of aspirant(number and sheet Gay,
state,and wPt da)
yo -10 7 C- £d.utoorour h Co
t 1aAds\nd,} 1 kit 31
Person authorized by duly executed Power of Attmnly or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dty,state,and ZIP code) .