HomeMy WebLinkAboutMortgage_Leek (2) n _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_[ ,q FOR DEDUCTION FROM ASSESSED VALUATION
Ill. State Form 43709(R11/6-09) P r'-T -per
S ,.I,: ° Prescribed by Department of Lod Government Finance I C_
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INSTRUCTIONS:
Form bled with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.S E P 2r`t i A
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought `d 1 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - 420.4:711---a unty Recorder
See reverse side for additional instructions and qualifications.
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GIA80N CO 1,., Y RUDITOR
Applicant contact buyer-see on reverse side)
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T isbict. S/[) CL
number/legal description Record number Page number
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Assessed value of real property as of =aye I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the eppG�t the sole
&Iamb 1;=rent year 1.a,rtrnt year date of aPPUCation or equitable aw er?
QSDD 0 Yes El 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 ❑AnnuallyAssessed
Motile Home QC 6-l.1-7)
Name of or contract seller— `/'7
Address of mortgagee or tract seder }`
(number enndsree. t,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)
Does appfuant own property in any other If yes,what county? • What Taxing District? (Has this deduction been requested at property
county in I ndana? for current Year? ❑ Yes El No
El yes ❑ No
COUNTYAUD I'
Deduction approved in the amount of. • DraWet.!NO a
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20 20 20 20 Card 11ro a'('/�/�./(�) . 1 f , .0
Signature of County Auditor County •••••••""°i ..
•......
I We certify under th Iry of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buy of the aforementioned property on date application is filed.
Slgnatu (ownefs futl name) mimeo
(_ /,,7/r/y� 7//�7 Date(month,day,}ear)
0`,A,�l •,(number .ALsfil'��_Jsttattte,and Lpdodel,l.l It IN 'J7(o70
Person authorized by duty execut Power of Attorney or by l�6-1.1-1122-00.7 Date(month,day,year)
Address of audoAZed person (number and saee4 city,state,and ZIP code)