HomeMy WebLinkAboutMortgage_Hill �:a_ : STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a
at FOR DEDUCTION FROM ASSESSED VALUATION
aura Form 43709(R11/6-09)
Prescobed by Depanmem of'Heal Government Firharrx
FQED
INSTRUCTIONS:
orm
b be fled in person or by mail with the County Auditor or County Recorder of the county when the property is treated.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought Auditor 2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months QQ
before March 31 of each year the deduction is sought - °url rder
See reverse side for additional instructions and ual 'cations. yn `- �j, .d —
l CO
T-.' rti.'.. , Key rypyb r/legal descrip.._ Raced u Nil'dui fir;
Assessed value of real properly as of 1►.-ge/Contract •-.tedness unpaid as of a/Contract Indebtedness unpaid as of Is the ap..,• t the sole
March 1:anent lean Mardi 1,anent year da on legal or equitable owner?
%. 22 - ❑ 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 record is different than that of appOcant.initiate below: b property in queslon:Annually Assessed
74-re
Property ❑AnnuatlyAssessed
/ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 1(pS.1 u - _ . �./ _
Address of mortgagee or contract se0 miter and 4 city, 4931811T 1T c 1 1 9 _
Drawer p?r//0//j,/
Name of assignee or other owner or holder of mortgage )\n0•.•[••�rY,� Hijk
Address of assignee(number and street,ctrl:Maid,and LP a Card IN O. ],q8/ •..•....
Does applicant own property in any other If yes,what county? . What Taxing District( •.•..•. �....._nt deduction been requested on property
❑ Yes ❑ No ( ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County 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 I ntract buyer of the aforementioned property on date application is filed. .
Signature name) 7/ Date(month,day.year)
mji, � /r// y/zo/�/•
F dent a of app (numberaM 4 ary,state,and LP code)
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 sbee4 city,state,and ZIP code)