HomeMy WebLinkAboutMortgage_Beckner ftoiSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) T
Preschb ed by Department of Loral Government Finance ° 1
File Mark
INSTRUCTIONS: 1`R' fled :l?.I c
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly/is located.
Filing Dates: 1) 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 during the twelve(12)months
before March 31 of each year the deduction is sought
cleat ecorder
See reverse side for additional instructions and qualifications. GIBSO ��•t111 AUDITOR
Appocant or Fonts=buyer- a ns ernre rseside)
T D' ct Key number/legal description Record number Page number
/(��[ -04-a 4-30o - occ a I a-Da o '0 3548
Assessed vadre of r Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 146t year date of application legal or equitable owner?
ICC 1�6n ❑ 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 ddferent than that of applicant indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Houle(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state, ZIP code)
-
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street coy,state,and ZIP code)
Does applicant own property in any other If yes,what county? , What Taxing District? Has this deduction bee requested on property .
county in Indiana? current❑ Yes ❑ No _ for current year? 1:1 Yes ED No
COUNTY AUDITOR
Deduction approved hi the amount of.
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,year)
I 1 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's hi nam Date(month,day,year)
Full rte address of a cant(number and sheet state,and ZIP code)
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Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .