HomeMy WebLinkAboutMortgage_Walton (2) Mt,
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�: FOR DEDUCTION FROM ASSESSED VALUATION
r%�' State Form 43709(R11/609) T T Prescribed by Department of Local Government Finance 1 EP
INSTRUCTIONS: Hor�o fiy� h
b be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.)UL 1 Y L U 1Y
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 „ ,�. eurllrjRecorder
before March 31 of each year the deductions sought -/{'/IPA-
See reverse side for additional instructions and qualifications. G IBS 0 N COUNTY AU(71TO R
S ontract buyer-see rgstr s on reverse side)nt
^ /KeY /number�l ega)�d /e.c� n Record number Page number
1 a1 - ii -/s. ror -oo.3. 6c'a -o . 7 /3 57/3
Assessed valued real property as of Mortgage/Contras indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
93 300 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than centre,indicate with whom
If name on record is ddferent than that of applicant.indicate below: Is the property in question:Annually Assessed
❑Real Property ❑MnuaMAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 573
Address of mortgagee or contract seller(number and street.city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and steel,city,state,and ZIP code) to. n ___ __
Does applicant own property in any other If yes,what county? I What Taxing K//7r��� �A /2--)
- '
county in Indiana? No
0 Yes 0 No
COUNTY AUDITOI //J
Deduction approved In the amount of:
20 20 20 20 20 _ _
__
Signs red Canty Auditor. `` '� County -Date(month,day,year)
V
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/contract buyer of the aforementioned property on date application is filed.
AS4 are(o: __ , { Date(month,day,year)
1 ' F resident address d applicant(number and street,city,stale,and ZIP code)
L/1�/ sago W.4;t tin P':n-ee,{.6w mil 1l747o
Person authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,yea _.
Address of authorized person (number and street.c/Y,state,and ZIP code) •