HomeMy WebLinkAboutMortgage_Deputy F,...k.-,y,_
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun W%Z" ! Year
: FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709(R11/6-09)
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Pnescobed by Department of Local Government Finance r
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INSTRUCTIONS: .
Form fled wi.
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. / �4
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought (3/e . • County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months Sl? i
before March 31 of each year the deduction is sought N 6 ,,, --" •er
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See reverse side for additional instructions and qualifications. •(in
Applicant(ownenoc buyer- on re side) (inn,
Applicant
Tan Key / +tesaiption Vv number P
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1;ogre it year March 1,current year date of appluation legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is(Edferent than that of applicant indicate below. Is die property in question:Annually Assessed
❑Real Property ❑MnuallyAssessed
_ - _. _ Mobile Hone fIC 6-i.1-7) _ _
Name of mortgagee or contact seller p l
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
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Name of assignee or other owner or holder of mgage y
ort
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? - initial Tatting Disv ? Has this deduction been requested on property
county in Indiana? ❑ Yes El No I 51_______/ ❑ Yes ❑ No
all./.y.;..
Deduction approved in the amount of: Drawer NO.. (lf/ (//J
20 20 20 ! •M• _ 20
!°�,"//,rte . Card N0. .... ......
59,� �" 11 QQty Auditor ''' wrr. day,year)
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I I We certify under the penalty of perjury that the above an. is a resident of Indiana and
owner I contract buyer of the aforementioned property on d: .
Signature(owners full name) . Date(month,day,year)
F_1!resident applicant(number and t,city, te,and ZIP code)
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Person 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 street,city,state,and ZIP code) -