HomeMy WebLinkAboutMortgage_Stiles (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ,j�'�j y �'�; .r
tFOR DEDUCTION FROM ASSESSED VALUATION I. i�
t) State Form 43709(R11/6-09) (�
Prescribed by Department of Local Government Finance .J1F,'he ni�lc L01'
INSTRUCTIONS:
Form fled 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: 1) Real Property Must file during the year for which the deduction is sought ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)montidl B SO N rrf}'TT99U Y
before March 31 of each year the deduction is sought `tom n��
See reverse side for additional instructions and qualifications.
Applea ror buyer-see restrictions an reverse side
ai m S to
(!av g Key number/legal descrip Record number P number
/a/ �o a� �a-�S i� 308 � ROIL/ gSFS
Assessed value of real proper./as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year Mardi t,anent date of appfcat on legal w equRabe awrleR
-757To0 ] Yes 0 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
Mobde l-iorne QC&-1.1-7)
Name of mortgagee contract seller /�
�2ar�cr- 4LeM�
Address of mortgagee or contract seller(number and street,city state,and ZIP coda) / t _
Name of assignee or other owner or holder of mortgage \�
Address of assignee(number anti street,city,state,and LP code) r�/•7)) e/./1rQ v t�y-.)" {- \
ara Does applicant own property in any other If yes,what county? - VV1- l •
county in lydBna? ❑ Yes ❑ No 78•X•.."�)`-•( 758 No
COUNTY AUDITOR / CO ,
Deduction approved In the amount of:
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 I contract buyer of the aforemet;% S property on date application is filed.
nature rs / n Date7-/6:, - /g
day,
year)
IC a/address• a (rum rand street aN. te, L code) Qc
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and=get,cry,state,and ZIP coda) .