HomeMy WebLinkAboutMortgage_Naas (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ?,RIB f!fl;iTtj±. :� Year
t:? '_ '
�� FOR DEDUCTION FROM ASSESSED VALUATION �`
'" . It State Form 43709(RD/6-09)
Prescribed by Department M Local Govemment Finance
MAY I2 **
•
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is local.• Form Orb -
•
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. - --.j1 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve 21 h.
before March 31 of each year the deduction is sought �'�t C 0 U VT C U @1319 f 32ecorder
See reverse side for additional instructions and qualifications.
Appfican wrueror contract buyer-seq
reactions onreverse rile)
. District Key number//legal Ption ,�`ur' n�`�•r'J Record number Page numbs
a( -oil-03-2w -Dos. 3s'1 Qty 00 9 solos
vase of real property as of Mortgage/Contract indebtedness unpaid as at Mortgage I Contract indebtedness unpaid as of Is the appfirant the sole
Matti 1,current year March 1,cement year date of application legal or equitable owner?
SSr 00 0 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,Indicate with whom
II name on record is deferent than that of applicant,indicate below: is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Borne QC 6-1.1-7)
Name of mortgagee or contract seller se
Address of mortgagee or contract seller(number and street,city.state,and ZIP code)
Name of assignee or other owner or holder of mortgage '7 ']
Address
� of assignee Lam sheet, state,4 ZIP
�code) a 7 ! �.J
Does applicant own property in any other If yes,what county? - What Taxing District? Nos this deduction been requested on property
county in indana? ❑ Yes ❑ No current Yew ❑ Yes ❑ No
COUNTY AUDITOR —
Deduction approved in the amount of
20 20 20 20 /��q
Drawer NO aw 1
Signa ea Canty Auditor .� County
I I We certify under the penalty of perjury that the above and foregoing information is true Card 1-d N 4(0.)5 1
owner/contract buyer of the aforementioned property on date application is filed. 452_/ 3 O%
Signature wneh AA nor ) lI ry _ ,) cad( r� n ,���lt r
` O t dress a Wpn!1 '(s IM1 Mysbe��UC�IJ/� (aryh\state.al 1 b5 -I-AT q!C7 3 I a
'],/•�( authorized by duyWexecuted Power of Anomey or by IC 6-1.1-12-0.7 Date(mama,day,year)
Address of authorized person (number and street.oily.state,and ZIP code)