HomeMy WebLinkAboutMortgage_Fougnies STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township I Year
*;t :-<;: FOR DEDUCTION FROM ASSESSED VALUATION
-, ,Ed. Slate Form 43709(R11/609)
Presmbed by Department of Lod Government For a e)A .
INSTRUCTIONS: Form tied :
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. 'n'
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought u I at, Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months Cou ry Recorder
before March 37 of each year the deduction is sought El
See reverse side for additional instructions and qualifications. ' "71111.
Apprritnt(owner or sid'e1 CISSON CuuNIY AUDITOR
•istrict Key number/legal d 'peon Record n��ear 1 a manber
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appGmnt the sole
Match 1.asters year Match 1,current year date of application legal or equitable owner?
'r ' 1 d D Yes ID No
If no,what is his es
/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is efferent than that of applicant.indicate below! �tIs real property in question Annually Assessed
l eal Property ❑AsnmlyyAssessed
f>1.1-7)
Name of or contract seller
Address of mortgag or contract 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,en 1 o U&(�o(�
coati t
Does applicant own propetry in any other v-.� r (� Ras this deduction been requested on p
Counry in Indiana? I i'TTp N y I for aurent Year? ❑ Ye5 o
. ❑ Yes t�,' o at m\ q�
1�• 51 W
Deduction approved in the amount of
20 20 20_ 20 20 20 20_ .
Signature of County Auditor `
County Data(month,day.year)
I I We certify under the penalty of perjury that the above and foregoing info:motion is true and correct and that the applicant is a resident of Indiana and
owner I co•..ct buyer of the af(oorrreerneer --tined property on date application is filed.
�SlgnaNro(oar• / - :) ber4 Dat/e/(no/r/d/t/(da(Y�.Year)
Full :: t:... • -1 t(num rd sheet city,state,and ZIP code) ?ley
•-..• authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,end ZIP code) .