HomeMy WebLinkAboutMortgage_Andis (2) f . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
F._:
FOR DEDUCTION FROM ASSESSED VALUATION
. - State Form 43709(R11/6-09)
Prescribed by Department of Loral Government Finance
INSTRUCTIONS:
To be tiled in person or by mail with the County Auditor or County Recorder of the county where the property is located. A,R f 1 ry
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought un 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 - ❑ Co to =- • 'et
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See reverse side for additional instructions and qualifications. I r '�""'•'
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Tai n.i; 6/ /ca'G ,61--/y°- do �- co/ faa- 2 dot/ P/&J7
Assessed value of real property Mortgage/Contract indebtedness unpaid as of Mortgage/Conuact indebtedness unpaid as of Is the eppdcant the sole
March 1,current year Mardi 1.ainent year date of aPP � legal or equitade smelt
❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on mind is different than that of applicant,indicate below
e uestn:Annually Assessed
❑Annually Assessed
Motile Home(IC 61.1-7)
Name of mortgagee or contract sellery
ct /
Address of mortgagee or contract seller( umber and street city,state,and ZIP code)
Name / `J`//7
Name of assignee or other owner or holder of mortgage 4 �J
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Address of assignee(number and sae,city state,and ZIP code) (/_(,}
Does applicant own property in any other If yes,what county? • I What Taxing Distr ct? I Has this deduction been
county in Indiana? far arrrmnt vaan_requested on property
❑ Yes ❑ No ] No
—
oz --/ / Q6v/-06/. 9�d-6-' 7
Deduction approved m the amount of xe rc) �1 •)I
20 20 20 cc ('J�\y�'y (� _
Signature of County Auditor t S l 1 \ 1 2 9 /7-ine*
IIne certify contract
buyer f the y of menti that the above S/ 1 / ed
owner/contract buye///r//pp�f the aforementioned property on dot � w
`, Sig pwners h/rtatN1 .
/y` Sid reside /off apappficant#aod C aTy, ZIP
7( s t Perof k )g)
Person authorized by duly executed Power of or by IC 61.1-124 r I ,..,�I
Address of authorized person (number and street,city,stare,and ZIP rot Ralq --- I I1V\//i