HomeMy WebLinkAboutMortgage_Short (2) a STATEMENT OF MORTGAGE OR CONTRACT IND itS O ty Township Year
c FOR DEDUCTION FROM ASSESSED VALUATION
t State Form 43709(RU/&-09)
Prescribed by Department of Lod Government Finance
�•- MAy 12 2014 File Mark
INSTRUCTIONS:
Form filed :
To be filed in person or by mail with the County Auditor or County Recorder of the county where th=prope ii. -•.
Filing Dates: I) Real Property:Must file during the year for which the deduction is sought. I �� i I \'(O" EL County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during .1C,-r •)hdil�i County Recorder
before March 31 of each year the deduction is sought GIBS‘"
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer- on re side_) p
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Onstrirl am}l1 Key number/legal desaiDlmrn Record rnumber Page number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March I current year date of application legal or equitable owner?
avU ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than'prune,indicate with whom
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
E8 al Property ❑Annually Assessed
Mobile Home oc 6-1.1-7)
I Name of ee or contract seller f1 y1 cam P p
mo
M.Address of ee or contract seller(number and street city,state,and ZIP code) —___—
-
Name of assignee or other owner or holder of mortgage - l/�//'�
Address of assignee(number and street city,sale,and ZIP code) ..Z-./I )/• .....•L/ V •
Drawer
Does applicant own property in any other If yes,what county? • 1/))AI /7 Ion property .
minty in Indiana? ❑ yes ❑ No ..l / ..... ❑ No
Card N-O• ... !1
COUNT'
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,year)
I/We 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 contact buyer of the aforementioned property on date application is filed.
nature(o _name) Date(month,day,year)sear_
F nt address of ars n/t�numb° rid street city,state,a n ZIP code)
K~ 0/ SO 1-1 KQCe .S dc% PMticeizj2) 9 2 )b
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 r Date(month,day,year)
Address of autha¢Ed person (number and street city,state,and ZIP code) .