HomeMy WebLinkAboutMortgage_Norton (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coup ea, "' •..ship`. Year
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� : FOR DEDUCTION FROM ASSESSED VALUATION ' %
� State Form 43709(R71/6-09) r / f� ,
Prescribed by Department of Local Government Finance
Fil- Mark
INSTRUCTIONS: - _- .
Forth m,•,11 T.
7o be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. .9
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. S County A6dimr
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)monem, t , -. Recorder
before March 31 of each year the deductions sought - S• - ,,ern1Y
• -
See reverse side for additional instructions and qualifications. • TY
Appfuanl(Aw buyer-sea on ve ® / 'IVQ)TO
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Assessed value thee!property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sale
March 1:camera year March 1,current year date of apPgmtion legal or equitable owner?
trv'7Q 'UYD ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than souse,Indicate with whom
If name on record-s different than that of applaud,trMiote below: Is property in question:Annually Assessed
Real Property ❑AnrlualyAssessed
Motile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee wmnoact seller in f,cliy,state,and ZIP rode)
Name of assignee or other owner or holder of mortgage
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Address of assignee(number and street,city stale,end ZIP code)
��e^plant cum property in any other If yes,what county? • What Taring District? Has this deduction been requested an property
❑ yes ❑ No for current
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount 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
owner I contract buyer of the aforementioned property on date application is filed.
Slg�gqre e�(ovmers fu0 ) \\ Date(rrmm, y,}ear" .
Full ent address of a t(4umberand street.' state, P cede)
X 91 S. ,�;.,1\e -t. A,_1\\C 0$ N\ 47h 7O . •
Person authorized by duty executed Power of Attorney or by 1C 6-1. -12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .