HomeMy WebLinkAboutMortgage_Skelton STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
CFOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/609)
Prescribed by Department of Load Government Enhance ®.��'+1—�.AqA
INSTRUCTIONS:b in per �—! m�
b be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. f�
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought. ❑ County Auditor
2)Mobile/Manufactured Homes not acsPcsed as Real Properly:Must file during the twelve(12)months
before March 31 of each year the deduction is sought RC fC ty,ter
See reverse side for additional instructions and qualifications.
Appca't(owrer orclo�ntrac bwyer-seee,est�oru m reeverse side) �Q -{� ,�/!/P/tZ�
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Taxing District . Key number/legal description Recd t' 'e niMAADI top
,� aC.- «- � - inn - nor)_°�9 - has I 3`l33
Assessed value of real property as of Mortgage)Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the apprrant the sole
Marts 1:arrent year March I,cyw¢nt�rC1/� date of epecation legal or equitable amen
J J � o [ 'es ❑ No
If no,what is his/her exact share of interest? If owned with someone other than • at.,indicate with whom
If name on record is different than that of appkant,indicate below. I Is the property in question:Annually Assessed
Ill 4P2eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seer E '--A ' 1
Address of mortgagee or contract seller(number and sheet.city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number end street.city state,and ZIP code) //„ �.yr 9 s 4 5J/( L. -rd '
. T/I rrr,I r zoo!-043
Does applicant awn property in any other If yes,what county •••••••••••••• requested p
county inlndana7 ,{-,� pra\Yen N nbeenr nested on m
❑ Yes hi No 4, „ n 0„),„:i� o'-c^' " . ❑ Yes Jo
Card d gip,'
Deduction approved in the amount of: •
20 20 20 20 20 20 20
Signature of Canty Auditor - I County Date(north,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 aforementioned property on date application is filed.
Slgpature(o „or/-me) c� Date(month,day,year)
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resident address of applicant(number and street city,state,and ZIP code)
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Person authorized 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,end ZIP code) .