HomeMy WebLinkAboutMortgage_Linder f . . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS , County _ Township Year -
.:: FOR DEDUCTION FROM ASSESSED VALUATIOIF II- / F I )
. jit State Form 43709(R11/rs09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUC17ONS: JUL 1 2014 Fomm filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: I) Real Property:Must file during the year for which the deduction is sought. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file dtLr(rq Mlle' onths
before March 31 of each year the deduction is sought NtC ❑ County Recorder
See reverse side for additional instructions and qualifications.
GIB/��7O/�'nN�CEOUj/NT��Y7EAUDITOR
ApDfranf(owner or b '/—17.7t6 an ra �e sdll C2,1e4',c , `-r`LJz `. Remit y�.., f `/ I I b�is-i8 -lo3-Co3.a98-cad Page
Assessed value of real property as of Mortgage I Contras indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,curare year Marts 1,w date of application legal or equitable owner?
RSoo ❑ Yes ❑ No
If no,what is his/her exact share of interest? / If owned with someone other than spouse,indicate wide whom
If name on record is different than that of applicant.indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Armually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller _` ge •
Address of mortgagee or contract seller(number and street,city,state. ZIP code)
Name of assignee or other owner or holder of mortgage
_.alnrnt,:at�o..•.em r.t.....we._. . _.,.,.......____...,o-ode)
1 J Q d-1 T)14 OPy K what county? - What Taxing Dishier? for deduction been requested on property _
Sit-404
Yes El No
/y -- ■J /-j ^� COUNTY AUDITOR
`7 20 20 20 20
I I
Signature of County Auditor • County Date(month,day,year)
I I We certify under the pen- • of perjury w1 at the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of -men a. property on date application is filed.
ir 0 year)
Date(month,da
1 _ rt/ III /I/ 5
Persona MM.by•uly exewt-a. •'. ey or by I :t.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .