HomeMy WebLinkAboutMortgage_Campbell a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a
iMi FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709(R11/6-09)
Presmbee by Department of Local Government Finance
File Mark
INSTRUCTIONS:
FTo be f iled in person or by mail with the County Auditor or County Recorder of the county where the property is I fed.Fling Dates: 1) Real Property:Must fife during Ne year for which the deduction is sought c I�I1 �otAuddw 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)monthSEJ LU�4
before March 31 of each year the deduction is sought - my Recorder
See reverse side for additional instructions and qualifications.
Ap.. •(owna4or contrail buyer eredriclions• reve,side I /1
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Assessed value of real property as of Mortgage/Contras indebtedness unpaid as of Mortgage/Conoar2 indebtedness unpaid as of Is the applicant the sole
Marsh 1,anent year March 1 gas ent y data of appration legal or equitable owner?
ci5D ❑ Yes ❑ 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:AnnualyAssessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or c o n t r a c t seller
IACakir ('1
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
Name or assignee or other owner or holder of rrartgage
Address of assignee(number and st eet,dry,state,and ZIP code)
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Does applicant own property in any other If yes,what county? . What Taxing District? Has this deduction been requested on property
county m iIndiana? for current year?El Yes ❑ Yes
❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 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/contract buyer of the afuwenlentioned property on date application is filed.
Signature(owner's fug name) Date(mo d),day,year)
Full addbsp ex^eumbe nd street, ,s of and /P eVy OO
Person authorized by duly executed Power Attorney or by IC 6-1.1-12-0.7
Date(month,day,year)
Address of authorized person (number and meet city,state.and ZIP code)
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