HomeMy WebLinkAboutMortgage_Allen (11) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FFF�`' FOR DEDUCTION FROM ASSESSED VALUATION plea✓➢dry
State Form 43709 Department/6-09) ��
Proscribed by Departrnent of Local Govemnont Finance /
File Mark
INSTRUCTIONS:
'� CC cos orm filed with:
b be filed in person or by mail with the County Auditor or County Recorder of the county where ro crayl51) ted.
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought W County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve( 2)
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications. sON COUNTY AUDI
TOF
•Appbp•t(owner or contractb .)-r-- q� Ilk IB 111►J► JL!� .∎ \ • _I ,_ t 11 % Si
n District Key number/legal description / Record number Page number
A oCk_t a 10— 55. -3 b- M 03 - 000 h5q -ocg9 l Li a69.
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Marti 1,oxcart year March 1,current year date of application legal or equitable owner?
30 000 ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on re cad's dfierent than that of applicant,indicate below: Is property in question:Annually Assessed
• eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller/CS _
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) /
Name of assignee or other owner or holder of mortgage � �) r , D
Address of assignee(number and street,city,state,and ZIP code)
li—I ate
Does applicant own property in any other If yes,what county? , What Taxi
county in Indiana? ❑ Yes ❑ No ❑ Yes ❑ Na -
COUNTY AUDITOR -
Deduclion approved in the amount et •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/contract buyer of the aforementioned property on date application is filed.
$'�y(\\ry\a(a Ml na i,) '�`''o�(\�/�/��' Date(month,day,year)
Full resident ' •umber and sheet oiy,sfa and ZIP��qqe)
y1 \ yJ • �.eAl )vcl . s-EG.uts- -0d* I)3 L1�J639
authorized by duty executed Power of rt. ey or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .