HomeMy WebLinkAboutMortgage_Phelps (3) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E[a,a:.
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RU
ment of gela:.� ,�
F
aresaroad by Department of sod Government Finance ill .
To be Ned in person or by mad with the CounlyAuditor or County Recorder of the county where the property is located.
Form filed with:
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought D� �qCburaywmitor
2) Mobile/Manufactured Homes not assessed as Real Property Must 5'e during the twelve(12)months
before March 31 of each year the deduction is sought - �❑ County Recorder
See reverse side for a itional instructions and qualifications.
Applicant(owner or buyer"see on sky G1950N COUNTY AUDITOR
Taxing District Key 1 l n description�`�/ h End I ►a_-oa 1 Record' I par 3' /
�� o g ram;
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1;wrest year Nlarr�t, t year data of appr�tion legal or equitable owner?
❑ Yes ❑ No
If no,what is his I 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 th property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Motile Home QC G-1.1-7)
Name of mortgagee or contract seller 6 a 3
Address of mortgagee or contract seller(number and street,cpy,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,tit Drawer NO.
Does applicant own property in any other -(./"(//)//�� Has this deduction been requested on properly
county in Indiana? ❑ Yes NO ✓ ``� //Lt—s' / �� for wrens year+
Card N�. �� ❑ Yes ❑ No
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Signature s County Date(month,day,year)
I 1 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 mentioned property on date application is filed.
(ocerY All name) (` Date(month,day,year)
t of appruant(number�sbee�aly,state,and ZIPI �\
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7"'G_(�` Date(month,day,year)
Address of aut cx person (number and street,oily state.and ZIP code) .