Mortgage_Green (8) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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Gf FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Presoibed by Department of Local Government Finance
Ale Mark
INSTRUCTIONS: .
Form filed with:
b be filed in person or by mail with the County Auditor or County Rcconfer of the county where the property is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications.
AppGrant(owne ontrart buyr-s an reverse side)
T W a legal Record number Page number
1 a ci-{a V L - 000. 1g3-pa 2
Assessed vale of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the app5m+t the sole
March 1:anent yea March 1,w year date of aPp�lon legal a equitable owner?
jrr ❑ Yes ❑ No
If no,what is his/her exact share of interest? if owned with someone other than spouse,indicate oath whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
/��o jv�{/'/�'� '• ,j//�//p�(/J���
Mobile Home(IC 6-1.1-7)
Name of mortgagee contract seller RrwsM`�+Li� (1 .hJI/r 1
Address of mortgagee or contract seller(number and street,coy, and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? El No for current year? Yes ❑ No
El Yes
COUNTY AUDITOR
Deduction approved in the amount of •
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20 20 20 20 20 20 20
Signature of County Auditor ' 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 1 contract buyer of the aforementioned property on date application is filed.
Signature(owners hA name) Date(month,day,year)
Full gtap t(number a te,and ZIP code)
P 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,c%stale,and ZIP code) .