HomeMy WebLinkAboutMortgage_McWilliams a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
bv:' FOR DEDUCTION FROM ASSESSED VALUATION
_r'`?�! State Form 43709(R71/6-09)
Prescribed by Department of Local Government Finance
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a. JL� File Mark
INSTRUCTIONS: ,,,,��yy yyp��,,/r��,,,,�y,,,pp t�
RftM'Y Kf'rb"CV Form coed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county wh ted.
Fling Dates: 1) Real Property Must file during the year for which the deduction Ls sought W County Auditor
2)Mobile/Manufactured Homes the assessed is Real Property Must file dunn the five ///"`"'"
before March 31 of each year the deduction is sought. ❑ County Recorder
See reverse side for additional instructions and qualifications. t
Applicant(owner or r- care. -sid ) nIRSOhl COU-ba DITOR
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�n Key num•: ••- description Record number Page number
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Assessed Match 1,curet year as of Mortgage 9ecoCentryu�indebtedness unpaid as of Mortgage�cttlebtetln— unpaid as of Is equitable app
0 Yes 0 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 the property in question:Annually Assessed
Property ❑Annually 11-7)
Name of mortgagee or contract seller
Address of mortgagee or contract 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 ray,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? ❑ Yes ❑ No for current year? ❑ Yes
❑ No
-• COUNTY AUDITOR
Deduction approved In the amount at
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n1 e LJ� " 5 I 1 bJ I 7
�nI County Date(month,day,year)
— j)4 - bB 1 I foregoing information is true and correct and that the applicant is a resident of Indiana and
U to application is filed.
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Data(month,day,year)
n'code)
, r(C%LC�U> Li tlLDe�$(l/ //e l,� 4744. 5
erson authar�d by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street.city,state,and ZIP code) .