HomeMy WebLinkAboutMortgage_Page (2) e"„ . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�..4 fr FOR DEDUCTION FROM ASSESSED VALUATION
- State Form 43709(R11/609)
Prescribed by Department of local Government Finance .L
INSTRUCTIONS: 1 .
To be tiled in person or mail with the Court Auditor or County Recorder of the county where the property
Form mail with:
Pe by County h N P PerfY totaled. II�''II��10:23:kunf5 Filing Dates: 1) Real Property Must file during the year for which the deduction is sought LJI
2) Mobile/Manufactured Homes not assessed as Real Property Must fie during the twelve(12)months
before March 31 of each year the deductions sought ❑ n Recorder
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See reverse side for additional instruU,bns and qualifications. u Appfrant(owner or r1m bq�er-sae re rim on repsiiiddde/')''7i'1—^�] ^1 GIBBON eTTYpr/!gb��+UDITCR
Tarir7g,p' - . �� i a 'R V -ape o -Doi . s a a-o o�,Record ibex' Peg(,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1:cYrent year March 1,w/rre'nS� date of application or n r equitable owner?
"1 d ( - ❑ Yes ❑ No
If no,what is his/her exact share of Interest? It owned with someone other than spouse,indicate w th whom
If name on record is dfIerent than that of appicant,indicate below: Is ere property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7L
Name of mortgagee or contract seller ° .1-low -in(l-ch -
Address of mortgagee or contract seller(numb and street,city Drawer e r N O :JD
(number
Name of assignee or other owner or holder of mortgage
Card NO. O1 // •. _
Address of assignee(number and street,city,state,and ZIP code)
Does applicant can property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current yeah ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor • County Date(ninth,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 con a buyer of the afore - boned property on date application is filed. .
g�awre(U ( ) J/ Date �� year)
residentta /address of apprk 1f(numeerand-r--4 aTy,state,and ZIP code)
/5/pr. pia ' �soF
arson authorized by duly executed Power of Attorney or IC 51.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,crty,state,and ZIP code) .