HomeMy WebLinkAboutMortgage_Blackard (4) e., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6r09) TB g9
Prescribed by Department of tnd Government Firmnce F I—tl E
INSTRUCTIONS: 9F0�ide I1 .
Form tiledva-
To be tiled in person or by marl with the County Auditor or County Recorder of the county where the property is located. S E�/+ 2 14
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought un Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Na during the twelve(12)months
before March 31 of each year the deduction is sought - C un e
See reverse side for additional instructions and qualifications. ~
Appecant(owne buyer see on reverse side) 011330N COUNTY AUDITOR
Taxing 04trict Pip,number/�g 31Q y 03- ODD. D 3 S-0 0 9 Record mxgmbel PVS `t
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact rt debtedness unpaid as ofof(]I)s�the applicant the sole
March 1:current year March 1. Year date of application legal or equitable owner?
l • ❑ Yes ❑ No
If no,what is his I 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 ❑Annually Assessed
• _ Mobile Home(IC 6-1.1-7)
Name of mrgagee or contract seller 5
Address of mortgagee or contract seller(number and street,city,.state.and ZIP a r/ ``^ i mi-(fr A t-
GEVE
Name of assignee or other owner or holder of mortgage
9509
Address of assignee(number and sheet,city,state,and ZIP code)
Does tyapp applicant own property in any other If yes,what county? • What Taxing District? I Has this deduction been requested at property
nun in Indiana? ❑ No for current ❑ No
❑ Yes ❑ Yes
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 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 aforementioned property on date application is filed. -
(owners full name) Date(month,day,year)
.i.a
Fu resident address o umber and street aIy,state,and LP e)
L I a lO a'nwoa.a • f`t c .� 4 20 3 9
Person authaited by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) -
Address of authorized person (number and street,city,state.and ZIP code)