HomeMy WebLinkAboutMortgage_Hamm STATEMENT OF MORTGAGE OR CON NDEB�,ED County Township Year
wi; - FOR DEDUCTION FROM ASSESSED V A It 1
` f f_ State Form 43709(R11/609) si -l.■1
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
FEB 27 2014 File Mark
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form 0ed
Fag Dates: 1) Real Property:Must file during the year for which the deduction' so h County Auditor
2)Mobile/Manufactured Homes
no assessed as Real Prope a twelve(12)months
year before March 31 of each cur the deduction is sougi8IBSON COUNTY AUDITOR ❑ County Recorder
See reverse side for additional insubctions and qualifications.
AppfEant( m .. c buyer see restrictions e)
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Pag�D
Assessed wake of real as as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the appin:ant the soil
March 1,arrant year J March 1,current /� 7'� date of appllcatron legal or equitable owner?
CXl✓oo0 ❑ 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 different than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Moe Home QC 6-1.1-7)
Name of mortgagee or contract seller (
Address of mortgagee or contract seller(number
street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and LP code)
Does applicant own properly in any other If yes,what county? - What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current yea? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at
20_ 20 //J1 20 20 20 20 20
Signs of ty 'tor 1/ County Date(month,day,}ear)
I I We certify under the penally 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.
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Signature n• _A . Date(month,daY.Y O
W^resident address of app/i ant�(numberand street,city,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 stoat,qty,state.and ZIP code)