HomeMy WebLinkAboutMortgage_Slone (2) f- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year .
FOR DEDUCTION FROM ASSESSED VALUATION
Le
Slate Form 43709(R71/6-09) F I L y
Presented by Department of Loral Government Pearce
File Mark
INSTRUCTIONS:
ff���c1 Fonn Ned with:
lb be filed in person or by mail with the County Auditor or County Recorder of the county wh}in0e prpyealocated.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 139 County Auditor
2) Mobile/arch 3 Manufactured each year not eduction i as Real Property Must file Burin die tore 0 County Recorder
before/Man fa to each year the deduction is sought
See reverse side for additional instructions and qualifications. ^IACf1N f`.()IINTV AUDITOR
(ownet or contract buyer-see core )
�y ,yZ 10 o'YLO
Taxing District - Key number/legal desaipuon Rm nu
ard rnber Page number
a-4U& l a 6-/ 9-JO - '900 Rao 75c7 aS aoi • -2
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contra=indebtedness unpaid as of Is the applicant the sole
Mara 1,cant year March 1,current year date of appicatmn legal or equitable owner?
❑ Yes ❑ No
If no,what is his I 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
Oral Property ❑AnnuallyAsessed
Jp r Mobile Home(IC 6-1.1-7)
Name of /IJR-�f_zi, ( 2/
d�mortgagee or contract seller(number and street ca).sue,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,and ZIP code) 2/4
Drawer NO
Does applicant own property in any other It yes,what count) - en requested on property .
county in Indiana? .. . ❑ Yes ❑ No
❑ Yes ❑ No Card NO. .. .... ...... •
Deduction approved in the amount at - -
20 20 20 20 20_ 20 I 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•• ct buyer of the •• ed property on date application is filed.
Signature(. _ Date(sonar,day.year)
1� its �.tl
Fug resident-...<of applicant( umber and street,aTy, ZIP e
a92F pass ti X74 K
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authottied person (number and stme4 my,state,and ZIP code) •