HomeMy WebLinkAboutMortgage_Eckert 6., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) YgN .
Prescribed by Department of Loral Government Finance .S'i E
INSTRUCTIONS: g
R)be filed in person or by mail with the County Auditor or County Recorder of the county where the Form filed with:
Y h h ty property is located. 2 Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought J Utj 2 C.20.4. for
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 - ❑ County Recorder
a • ..Ii
See reverse side for additional instructions and qualifications. 74 i9 FT ill rrr7/1
i I, . ' I •-/. Al A _, r
Tai ti Irl ,.ber/legald>.'�. Record number Page it •.
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Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/ indebtedness unpaid as of Is the p t the sole
March 1,and year March 1,current year date of app ' t tilegal or equitad 0 Nl
Cap ❑ Yes No
If no,what is his I her exact share of interest? If owned with someone other'than spouse,Indicate with whom
If name on record is different than that of apt,indicate below. Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(n 1•
other street ray,state.and ZIP code)•
Name of assignee or oer owner or holder• -
Address of assignee(number and srree4 city,state,and ZIP code) yObi-15 �(/ r'U Does applicant ovn property in any other If yes,what county? - t Taxing District? Has this deduction been requested on property .
county in Indiana? ca
❑ Yes ❑ No for rtent year? ❑ Yes ❑ No -
COUNTY AUDITOR
Deduction approved in the annum of
°ACorA I A - - 20 20 20 20
Signs Drawer NO
�•� County Date(month,day,year)
I/ Card NO. I foregoing information is true and correct and that the applicant is a resident of Indiana and
cm e application is filed.
Sign # a 7r cm Date(month,day,year)
Full resident address of applicant(number and street dry,state,and ZIP code)
$ SOS S. H0.1( St-, ,V(2. nce--Fcs 1 1 NI (411s—I0
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .