HomeMy WebLinkAboutMortgage_Snapp �,_ .f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:$k;I;: FOR DEDUCTION FROM ASSESSED VALUATION
• ''' 4-• State Form 43709(R11/6-09) 4
Presm'hed by Department of Loral Government Finance i Nrpn � 'M—' °
_NSA 3+- Laren
INSTRUCTIONS: .
To be filed in person or by marl with the CouniyAuditor or County Recorder of the county where the property is located. o
Form mart
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought 01,I J 20 County Auditor
2)Mobile/Manufactured Homes not accenced as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought JLLL,i,(!/ _'eutrJJJ�yyy000uuunty Recorder
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See reverse side for additional instructions and qualifications. `t-{I� S. , n
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T. yq• 'W �._ /leg= ••',tion 7 ^j Le-2 -7 Record number Page number/
Assessed value of "� Mortgage Contract OC indebtedness°`--RIO �as of Mortgage I tac indebtedness unpaid Is the ap�ttth the
Maids 1:arrant year 148, 9771 year ^ date of application legal or equitable owner?
l ❑ 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 retard,Went t than that of applicant,indicate B� Is the property in question:Annually Assessed
({y-,�r--t\,/{ ,)))000 ❑Real Property ❑Mnnuallom Assessed
6
Mobile I-tome(IC 6-1.1-7)
Nacre of mortgagee or contract sal r
Address of mortgagee or contract seller(number and street,may sate,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 Taxing Di strict? Has this deduction been requested on property
marry in Indiana? ❑ Yes El No for current year? ❑ Yes ❑ No
COUNTY AUDfTOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor 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/contract buyer of the aforementioned property on date application is filed.
\Signature(ovm fugname) Date(month,day,year)/CT
iA ens address xt number and&been ay,,state,and ZIP Cade
ozc'{`�t(F HOC, F, th �- • �, P-L,
Pe:615a OyG@/used Power of Anorreay IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,city,state,end ZIP code)