HomeMy WebLinkAboutMortgage_LaRue STATEMENT OF MORTGAGE OR CONTRACT INDEB 4LE Township Year
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�t' FOR DEDUCTION FROM ASSESSED VALUATION
t State Form 43709(R11/6-09) 7 201/4 Prescribed by Department of Local Government Finance MAY 2
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INSTRUCTIONS: m
To be filed in person or by mail with the County Auditor or County Recorder of the county where thq'q�,- - F filed o-
Filing Dates: 1) Real Property:Must file dining the year for which the deduction is sought. j•W� ��yTY AUDITOR �Counry Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file Tr2)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applcant( contact buyer-ciVrilons an e) v / �r - 1
Taring District Key number I legal d con Record number Page number
6-/o - 35-5CC ar 1597-o7 aaiz/ /97K
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact inde ess unpaid as of Is the applicant the sale
March 1,anent year March 1,anent year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is ddferent than that of applicant Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually A
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller iI Ro
Address of mortgagee or contact seller(number and street city,state,and 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 property in any other If yes,what county? • What Taring District? Has this deduction been requested an property
county in Indiana? for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I l 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,/contract buyer of the aforementioned property on date application is filed.
natu .`..weer'htl • ) f 9 Date(month,day.year)
-kW.-nt address of a•:ii nt(number and street,city state,and P code)
P ►D O Z 'e S k9D �Sed1� C�lev1S\Uie \ 1N I1 U USY year)
Address of authorized person (number and street city state,and ZIP code)