HomeMy WebLinkAboutMortgage_Chandler (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
br FOR DEDUCTION FROM ASSESSED VALUATION
��-3.�`'� State Form 43709(R11/e-09)
Prescribed by Department of Local Government Finaroe ) i•
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INSTRUCTIONS:
fy11 nn Form lied with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is loca�rl� 7
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought 1 County Auditor
2) Mobile/Manufactured Homes not assresed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
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See reverse side for additional insbuctbns and quar lions.
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AUDITOR
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1� 9a -0..2 2 —Record mar Page-
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Assessed value teal spry as of Mortgage/Contract indebtedness unpaid as of Mortgage!Comae' unpaid as IS the applicant a elite
March 1:anent year //. _ March 1,current year data of application legal or equitable wrt�1
�
If no,what is his 1 her exact share share of Interest? If owned with someone other than I 6616� ❑ Yes El No
pouse,indicate with whom
If name on record is different than that of applicant,Indicate below. Is the
property in question:Annually Assessed
Real Property ID AnrluallyAssessed
�C' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
/0--/ /6/2
A
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 steel,city,state,and ZIP code) L C71 6 f
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Does applicant own property in an _ag . . ? Has this deduction been requested on property
matey in Indiana? for current year?
❑ YE ill,I�'I�1�,,J�/`-p� CI („ci ❑ yes ❑ No
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Dedumen approved in the artour. () �)
20 21 I�'I — 4y -1 20 20 20_
Signature of County Auditor 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. .
(owner's(ir0 rte / 8,Nd c/„„� 'n, Date(north,day.year)
a )Y�l IU Y /M/ C/l/IV //ALJ
FW reprient of t(number and street aty, and n Pcode)
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Person authored 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)
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