HomeMy WebLinkAboutMortgage_Kolhouse (3) rte^El . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
te-,` FOR DEDUCTION FROM ASSESSED VALUATION •
State Form 43709(RU/609)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located. Form fl j
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought my Auditor
2) Mobile/Manufactvred Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought my*fder
See reverse side for additional instructions and qualifications.
Appfic2n((mrp9r rmmraa byyer-see n2tis- on )/ ties
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T ''�pistict Key number/legaa desc description Record Page nurt�Pst Q
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Assessed value cereal property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Marts 1,current year March 1,current year date ofpgpficotion legal or equitable owner?
/IV 600 ❑ Yes ❑ No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below- - Ls the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet city.state,and ZIP coda)
Name of assignee or other owner or holder of mortgage �fn r /J
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Address of assignee(number and street,may.date,end ZIP code)
Does applicant own property in any other I If yes,what county? What Taring District? Has this dedumon been requested on property .
county in Indiana? I-7 _ I District? as for current year/ ❑ Yes ❑ No
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COUNTY AUDITOR
114 - 295
20 I 20 20 20_ .
Cattily 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 ntract buyer of the aforementioned property on date application is filed.
es Dateee(/(m addaay,year)
X F enter t(number and strae4 dl�tyy7 state,and ZIP code)
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Person authorized by duty executed Power o1 Attorney or by 161.1-12-0.f r Drate(month,day,year)
Address of authorized person (number and street rity,state,and ZIP code) .