HomeMy WebLinkAboutMortgage_Bush (2) a . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County", I Toy�tishlp '% Year
w,o; FOR DEDUCTION FROM ASSESSED VALUATION
-�,. t State Form 43709(R11/609)
Presmbed by Department of Local Government Finance
NU V 3 FileM44(
INSTRUCTIONS: .
Form filed with:
To be hied in person or by mad with the County Auditor or County Recorder of the county where the property is located. �
FlTmg Dates: 1) Real Property:Must file during the year for which the deduction is sought. lm.L f County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12))�monthsJ C C U N A Couiily;l2ecorder
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Apps (owne`cr mnbact buyer-see restrictions on reverse side)
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453 District Key number/ gal dewiption �j Record number'/ P e
at,-/a- o5 goo -00% ig /0 - oeS/ clo/ t
. Assessed value of real propeny of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1;extent year March 1,anent year date of appfcatron legal or equitable owner?
fy'a,5oo ❑Yes El No
If no,what Is his/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 ❑ArunrallyAsSCSS d
. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller £ 2>L1
Address of mortgagee or contract seller(number end street,thy.state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address
sr����oof assignee(number and Fskeet,c�3:state,and ZIP code) -
c iJUS� r z/1�//v(/ r /.r What Taxing Datrict7 Has is deduction been requested on property
for�.//C ❑ Yes ❑ No
Cy2)771- COUNTY AUDITOR
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20 20 20 20
/',t,, County Date(month,day,year)
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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. .
Signawre e) Date(month,day,year)
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A..., F / / �ad D W � ra 4�:state,and Z/ a) //A �•I �" O•
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Person authorized by duly executed 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) .