HomeMy WebLinkAboutMortgage_Burr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
tidyFOR DEDUCTION FROM ASSESSED VALUATION
1:- State Form 43709(R71/6-09)
Prescribed by Department of Local Government Finance
File E
INSTRUCTIONS: uu
M be filed in person or by mail with the County Auditor or County Recorder of the county where the property F
Filing Dates: 1) Real Property Must file during the ry b P locates
ng 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 - ❑ mMure' 4
See reverse side for additional instructions and qualifications.
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Taxing DLstrict Key number/legal description Rarer NL. ( \U (TOR
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Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage/Coniract'i indebtedness unpaid as of Is the apt a sole
March t,current year I Marc amen yearn date of application legal or equitable owner?
O 0lat_) ❑ Yes ❑ No
K 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.Ndicate Delmer: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Motile Hone(IC 6-1.1-7)
Name of mortgagee or contact seller r
Address of mortgagee a contract seller(number and sheet,city sm a ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city,state,and ZIP code)
Does applicant own propertv.ia-. ' — IN? , What Taxing District? Has this deduction been requested on property
county in ortr? for current year?
❑ Yes ❑ No
COUNTY AUDITOR
D7aNie ' 10•.
(al .-, 20 • 20 20 20
Sign Card ) ••. County Date(month,day,tear)
I I ..e 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 con•-. buyer of the aforementioned property on date application is filed.
Sig :. -41:1.:. huli na• ' Date(month,day,year)
till-_..en address of..•r.-1t(number and stee state,and ZIP code)
4.-. authorized by duly executed Power of Attorney or by IC 6-1.1-124.7 Date(month,day,year)
Address of authorized person (number and street city state,and ZIP code) .