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HomeMy WebLinkAboutMortgage_Clark (4) STATEMENT OF MORTGAGE OR CONTRAC)N D County Township Year it FOR DEDUCTION FROM ASSESSED VALUATION _ �';S t't State Form 43709(R1116-09) -'� Presaibed by Department of rod Government Finance AUG 15 2014 File Mark INSTRUCTIONS: lb be filed in person or by mail with the County Auditor or County Recorder of the cotin'ty whe ' ,p s located. Form filed w . Filing Dates: I) Real Property Must file during the year for which the deduction is County Auditor 2)Mobile/Manufactured Homes not assessed as Real Prop€l:113 416)worths before March 3l of each year the deduction is sought County Recorder See reverse side for additional instructions and qualifications. I � �/fQ{ eC � `C/LL(�12f,I (//yam/I\jRe�/j���pe(�� 1 T ILY-�ll�� numbed—IT-I 9-40o-coo.o.0I7-00t 1 Nn6 PSI (JC1J Assessed value of real popery as of Mortgage 1 ConDact i debtednes unpaid as of Mortgage I Contract indebtedness unpaid as of Is the app&ant the sole Mandl 1,anent year Marctr t.aq'�nt yrsrgO©O date of appGrarion legal or yobs �l 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 �� //�1 '/ Mobile Home(IC 6-1.1-7) Name of mortgagee o contract seller n n y / _ //� Andres of mortgagee or contract seller(number and street city state,ar(/�/ZIP code) Name of assignee or other owner or holder of mortgage Andres of assignee(number end street arty,state,and ZIP code) . Does applicant own property in any other If yes,what county? What Taxing District? Has this dedumon been requested on property . county in Indira? ❑ Yes ❑ No current Yin ❑ Yes ❑ No - COUNTY AUDITOR . Deduction approved in the amount at —on I. 20 I 20 20 20 20 20 . (.;:c79,/e._,/ — City Date(month,day.year) Draper NO foregoing information is true and correct and that the applicant is a resident of Indiana and "� rte application is filed. Card NO. ��� Data(month,day,year) /P code) >v �jo �I I- {� `� �� t()n s A) �(1 b&o Person autOraed by duly executed Power dfAtrorney or by IC 6-1.1-12-0.7 Date(month.day,year) Address of authorized person (number and street city,state,end LP code) .