HomeMy WebLinkAboutMortgage_Mckannan (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township I Year
p'` r FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R11/5-09)
Pt scnbed by Department of Local Government Futon
File Mark
INSTRUCTIONS:
7b be filed in person or by mail with the County Auditor or County Recorder of the county where the poperty R
Filing Dates: 7) Real Property Must file during the year for which the deduction is sought I j '•
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months MI
March 31 of each year the deduction is sought
See reverse sid for additional instructions and qualifications A U
Applicant(owner runt=buyer-see restrict/ion reThse)K
Priltr
Taring District tito—I r—o,legald description)I o&4. 315- oa? GIBS t
ed
Assess value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,aurent year March 1,amentryparo co date of application legal or equitable owner?
I IY/_ Yes No
If no,what is his/her exact sham of interest? If owned with someone other than spouse,indicate with whom
If name on record is dRerent than that of applicant indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller S
Address of mortgagee or contact seller(number and 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 ZIP code)
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Does applicant own property in any other ..............
O I✓J Has this deduction been requested on properly
county in Indiana? ❑ Yes ❑ I '7 for current year?
Drawer NO•••• ❑ Yes ❑ No •
31aI
Deduction approved in the amount of Card NO. .....................
41i5115955b_
20 20 ' — 20 20 .
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Signature of County Auditor • County Data(month,day,year)
I 1 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 contract buyerr of the aforementioned proper y on date application is filed.•
Data(month,day,'Agi(owner's s u'no ) i/ li 6 v\ lLV
Full e o (number and sbee and ZIP code)
x Inl a 0Rfoe _. -?11 act-04 IN ((-7(p7Q
Person aut prized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year) _
Address of authorized person (number and sheet city.state,and ZIP code) .