HomeMy WebLinkAboutMortgage_Knowles (4) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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v�1: FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: AAA
Form teed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought (��7 �O' ❑ County Auditor
2) Mobile/Manufactured Homes not acs eyed as Real Property:Must file during the twelve fa loo
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications. n`.''Lr
Applicant wneroe tetrad buyer-see restrictions fictions on to rse side) M w
(.(.. St a GIBBON UNT AUDITOR
T District Key number/legal des 'on Record number Page number
a/ - i7 - 0 3 - Yoo - 00/ . 9.3 9-oaf 20 I a.so y
Assessed value real property f Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sale
March 1;amnt year March 1,cement year date of application al or owner?
r equitable oer?
9,5 DOO ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than s ,indicate with whom
If name on record is different than that of applicant Indicate belorwr. Is the property in question:Annually Assessed
❑Real Property ❑AyAsseSSerl
Mobae Home QC 61.1-7)
Name of mortgagee or contract seller nn ''
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Address of mortgagee or contract es(number and street,cty.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 applicant own property in any other If yes,what county? • What Taring District _' h'san renuested on property
county in Indiana? 9
❑ Yes El No 451 000•��
COUNTYAUDITOR Di'awer NO' .40141
Deduction approved in the amount of "'• •20 20 20 20 20 C 1'(j �r O- �W I _
Signahue of County //k 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 I contract buyer of the aforementioned property on date application is filed.
Signor_re Ymet name) (Am. 1 4 - Date(month,day,year)
/FWl�� t--, _W3.ofd.•.. t ben abeet dly,state,and ZIP code) .
Person au ? by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored person (number and street.city,state,and ZIP code) •