HomeMy WebLinkAboutMortgage_Perry (17) c:. _-. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS .County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of local Government Finance
ILED
INSTRUCTIONS:
Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. ^A' op 9nnffcc
Hilly Dates: 1) Real Property:Must file during the year for which the deduction is sought J41 5 O tSbuRry Pltd'dor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months u
before March 31 of each year the deduction is sought - A ❑ County Recorder
See reverse • e for additional instructions and q ificatbns. '"17 -.Pn1►j,
�«m�g�o-qar�buys / m sae ) �'IPSON COON Nil'AUDITOR
/1/.(iyO Y' /��4J j iS
T �/_, Fyn -4? /a'-tai 6Qa Z-- 2 Record rQ ;
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mash 1:anent year March 1,anent year date of apt legal or equitable owner?
P 3 aen ❑ Yes ❑ No
If no,what's his/her exact share of interest? If owned with someone other than space,indicate with whom
If name on record is afferent than that of applicant,Indicate below. Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(nu and street city state and ZIP code)
Name of assignee or other owner or holier of mortgage 1
Address of assignee(number and street,all:state,end ZIP code) / �)�� /� / /
Does applicant own property in any other If yes,what county? • What Taxing/Distric]+I/District? //V// Ras this bled (O/nedmr n req��on property
county in Indiana? rent yea/
❑ Yes ❑ No for ❑ Yes ❑ No
COUNTY AUDITOR
Deduction appro -----—_ _
468 SCb.6• Pte.
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20 at, • 20 20 20
Drawer NO aOIY P
Signature of Co • County Date(month,day,year)
Card NO. 153?
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,rnation is true and correct and that the applicant is a resident of Indiana and
('�,� own- •ntract buyer of the aftneme boned property on care apM•w.,..,,is filed.
./�1r7 &lb* Date(month,day.year)
µII - '•ent pprrant(number and street,city,state,��'Pcode)
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Person authorized by duty executed Power ofAtto Attorney or by IC 1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .