HomeMy WebLinkAboutMortgage_Marginet (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES8 ri iii
F°ra. ' i1�i�'J. ship Year; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R71/6-09) I' I1
Presmbed by Department of Local Government Finance
File Mark
INSTRUCTIONS: .
To be filed in person or by mad with the CountyAuditor or County Recorder of the county where ry and tied wtu
Fdmg Dates: 1) Real Property.Must file during the year for which the deduction is sought. ON COUNTY •UDRRCcunty Auditor
2) Mobile/Manufactured Homes not amassed 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 qualifiications.
(owner or contract buyer-see reverse side)
Tip � ,Y. . tail r11 Q n
Taarg Ii"ey number description Record number Page number
a4,_fr 9-2oo -. .C/ -S// -oaf a () i4 591ca
Assessed value areal property as of /Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfcant the sole
March I;drat year arrtent year date of appliicetion legal err equitable owne?
9DQod • ❑ Yes ❑ 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 different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑ArtrurallyAssessed
• Mobile Hoare(IC 61.1-7)
Name of mortgagee •• tract seller
•
Address of mortgagee•I; tratl er(number and street,city -u e,and ZIP code ---
FY I any in'i7�cilx�-.
Name of assignee or other owner or holder of mortgage 11 CO' CU1
iii Address of assignee(number and street,city,state,and ZIP code) I O r NO 401,1 ,,,,.....
Drawer .:.••..•.
Does applicant own property in any other If yes,what county? • WI GM f I A rope ty
county in Indiana? "� ...,,,.
❑ Yes ❑ No Card NO. .....................
❑ No
COUNTY AUL
Deduction approved in the amount of: •
20 20 20 20 20_ 20 20
Signature of Canty Auertor County Date(month,day,year)
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/.•ntract buyer of the aforementioned property on date application is filed.
Signatu .///� me) Date(month,day,year) ry
tt a pp (mum an0 stree4 aA1 sbte,and LP code)authorized by duty executed Power of Aa sney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sleet,city,state,and ZIP code)