HomeMy WebLinkAboutMortgage_Perry (20) � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS my Township Year
FOR DEDUCTION FROM ASSESSED VALUATION g
F
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orm Fa 43709(Rtt/&-0g) 1
Prescribed by Department of Local Government Rrunce .
File Mark
INSTRUCI7ONS: JUL 2014
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Fomn mad with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. 4� County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file durirt�lhe onths
before March 31 of each year the deduction is sought Jf 'I"M�o'n.COUNTY AUDITOR 9 County Recorder
See reverse side for additional instructions and qualifications. GIBSON COON
Applicant act drmmntrarl6uN'r-s¢Key number/ aIerss
Teri •Di tact Key number/ I description ' Record number Page number
• ./. // .. i/ —O - - - (5/ _ - - O/ .. D'
Assessed value of real•'..•., as of Mortgage/Contract indebtedness unpaid as of Mortgage I Comract indebtedness unpaid as of the applicant the sole
March 1,errant year Mardi 1,cement year date of application legal or equitable owner?
!) no ❑ Yes ❑ No
If no,what is hhis/her exact share of interest? (/ /7 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 QC 6-1.1-7)
Name of mortgagee or seller
Address of mortgagee or tra seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,(se.state,and ZIP code) ___--�`
Does applicant own property in any other If yes.what county? .What Taxa my .
county in Indiana? '
❑ yes ❑ No
COUNTY AUDITOR Drawer NO•.o..O.a• ,. No
Deduction approved in the amount of. C.{'
20 20 20 20 Card NO. ..•..
I
Signature of County Auditor • County Date(month,day,year)
I 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 I contract buyer of the aforementioned property on date application is filed.
Sig (owner's furl name Date(month,day,year)
kArelrs�i.dent appfranI q(number city,state,and ZIP code) 1 1
CUP) € . 516 6 �C�1 b o�_ N — 1 119 tO Ili `
Person authorized by duly executed Power of Attorney or by IC 6-1.11-12-0.7 _ - Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)