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HomeMy WebLinkAboutMortgage_Cline (2) ,fist. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION I 1� State Form 43709(R11/609) Prescibed by Department of Local Government Finance -FitilatC i F7 INSTRUCTIONS: . To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form tiled With: HP� ��� Filing Dates: i) Real Property Must file during the year for which the deduction is sought ©P 2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(72)months before March 31 of each year the deduction is sought ❑ County Recorder See reverse side for additional instructions and qualifications. 7..t n jG Applicant(owner or contract buyer-seerrsriraons onmversesde) ' es IbSUN COUNTY AUDITOR c o- et)vb )l� kc �c i Taxing D' • Key number/legal desaipe Record number Page number 0� S1. 2- , t/-/g' - .30a --00&.l8d _o07 2.oi c{ ti 00a Assessed value of real property as Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole March 1:anent year Mardi 1.current year date of application..., legal or equitable owner? IQ/ 0 .70 ❑ 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 drfrerent than that of applicant,Indicate below Is the property in question:Annually Assessed ❑Real Property ❑Annually Assessed • Motile Home(IC 61.1-7) Name of mortgagee or contract seller 5/3 Address of mortgagee 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,and ZIP code) CC-4C ,,eem- ) -7 Pr ( P7 9A% 4-41 . 3 Does applicant own property in any other If yes,what county? • What Taxing 1 „ , \ 'C county in Indiana? 1-- I_A - ❑ Yes ❑ No \\ ,('�f� f�j� COUNTY AUDITOR ` \�i I \O�rftUt) l Deduction approved in the annum of: 20 20 20 20 I U ( D'-O Signature of / County (go(0 ,41005" "'C ^ 5" II We certify under the penalty of perjury that the above and foregoing information is true anc owner/contract buyer of the aforementioned property on date application is filed. )(Sgnaaure(owner's rue name) 0 �asw:� .--r �s. 4,/ Full residR address of ap t(number and street aly,state,and ZIP code) t a 3 W . rit ras-r , son St. Or>tcJ.cur--k G',t. Person authorized by duly executed Power of Attorney or by IC 6-{1-12-0.7 Address of authorized person (number and street city state,and ZIP code) .