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( "��a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
fctlr FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(Rit/6-09) Y
,y„ Prescribed by Department of Local Government Finance 9
INSTRUCTIONS: .--111���i��i�!
To be filed in person or by mail. A P&oqi 6 � uA
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 11 Y
Must be filed with the County Auditor or County Recorder of the county where the property is located ounty Auditor
on or before January 5 of the immediately succeeding calendar year. n un corder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each yoirtbeON
deduction is sought id ON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Bello,Jodi Ann
Taxing District i Key number/legal description Record number Pa nu bee
OWt/1Svt IBC 26-17-12-204-000.480-022 0701 {I�(, v'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid or h the appli the sole
Mardi 1,anent year March 1,anent year date of application legal or equitable owner?
103,550.00 `[AYes ❑ No
If no.what is his/her exact share 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:Annually Assessed
[$�Real Property ❑Annually Assessed
r _
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sever
PennyMac Loan Services
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
6101 Condor Drive,Moorpark, CA 93021
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes III No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I rtifyt 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 tra uyer of the aforementi n pro' erty on date application is filed.
ature(o nets name) V� 1 Dat on7 ay,7e1
Full re ident address of applicant(number and ,city state,and ZIP code)
402 South Main Street,Owensville, IN 47665
Person authorized by duly executed Power of 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)