HomeMy WebLinkAboutMortgage_Northside ea.a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS noun t ,aa_hip Year
FOR DEDUCTION FROM ASSESSED VALUATION %
'' State Form 43709(R11/6-09) ; Si -!
Cc Prescribed by Department of tad Government Finance
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INSTRUCTIONS: J A
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Fona W 2011
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. 1 0 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)m ■
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before March 31 of each year the deduction is sought N COV 7Iq',4,: -ecorder
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See reverse side for additional instructions and qualifications. Al Unf
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vslue real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1;arrant year March 1,accent year date of apptcation legal or equitable owner?
/ i000 ❑ 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 afferent than that of applicant,indicate below Is property in question:Annually Assessed
eat Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
6e "One,
Address of mortgagee or tooted seller(number and t,city and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city state,and Li Drawer N U 2oi �f
Does applicant own property in any other If y is deduction been requested on property
county in Indiana? Card NO O / •—lt� ant year? El yes ❑ No
❑ Yes ❑ No
•
Deduction approved in the annum 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
owne contract buyer• the mention property on date application is filed.
iKSigna jie MI-. J Date(month,day,year)
_
Full .; d• appf t(number nil street ray state,and ZIP core)
erson authorized by duty executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet dty,state,and ZIP code) _