HomeMy WebLinkAboutMortgage_Rainey (2) t ate. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year ,
tFOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
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Prescribed by Department of local Government Finance
File Mark
INSTRUCTIONS: `a
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is 1 �i I.,.,•
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought I t ; Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12) hs
before March 31 of each year the deduction is sought U County Recorder
See re side for additional instructions and qualifications.
Al • : 1 ,
Apprim wner or contract.r,-r-see - retie -;side)
Taxing Key number 1 al desaiPtan • • .f .. T( i
02� —9a s- jw C�a ti y88 f. y GIB rYy Y PB I k 3
Assessed value of real popery as of Mort gage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant liY the sole
March 1,commit year March t,ygep year date of application legal or equitable owner?
U—r)I/p 'It
❑ Yes ❑ No
If no,what is his/her exact share of interest? if owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,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 /N1
I •
Address of mortgagee or contract seller(number and street ,state.and ZIP code)
• Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) ('j `
Does applicant own property in any other If yes,what county? • C Y'1 ••-
county in Indiana? ❑ •
No `J NNN
❑ Yes 5 Z\ \ ❑ No -
COUNTY `-\ \\wv(
Deduction approved in the amount of: 1
20 20 20 20
Signature of County Auditor • a E /^ V-
I/We certify under the penalty of perjury that the above and foregoing inf .•iana and
owner l contact buyer of the aforementioned property on date application
'id (o es hi a
aan(num rand 4 city,state,and ZIP code) ! r l
2 ►rU. ► S, }�aubs�-ad-} / /F/ V71 3?
uthorized by duty executed Power of Anorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of autlwized person (number and street city:state,and ZIP code) -