HomeMy WebLinkAboutMortgage_Sefton .:a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALU {��'`1�
II State Form 43709(R11/6-09) �_J 2LJ
Presoibed by Department of tncal Government Firwhce ri __
File Mark
INSTRUCTIONS: InMFF(('' 99 - -- .
To be filed in person or by mad with the County Auditor or County Recorder of the core y chJerthe
Form Ned veldt
Pe Y b ly rty is located.
Fling Dates: 1) Real Properly:Must file during the year for which the deduction is sought. Q-unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must f7t:,during tw rmonths
before March 31 of each year the deductions sought ,IIL ,. ❑ County Recorder
See reverse side for a'.'itional instructions and qualifications. G ;SON COUNTY AUDITOR - --
ng r ■ Key /legal description
�—aa I -aob -403.3V-0.14 /4 Pimps O
,.value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
1:asmtd year March 1,anent / date of application legal a equitable owrhe?
77 10355 - ❑ Yes 0 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 ddferent than that of applicant,Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
! Mottle Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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 street,cot state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been requested an property
county in Indiana? El No for current year? Yes ❑ No
❑ Yes
COUNTY AUDITOR
Deduction approved in the amount of: •
20 20 20 20 20 20 20
1
Signature• I. ..ty Auditor i I County Date(month day,year)
_i! dAuditor. ] I 1 _ .4i& _'
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.
more(owne/5Iy0 / Date(month,day,Year)
resident 6daddress of ap t(rntmmbe(a� ary,state,and ZIP code)
b /JY R s /c w€f - 1 et,bs 1l- rAl (--17 -7c?
Person Person authored by duty executed Power of Attorney or by IC 6-1.1-12-6.7 Data(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) •