HomeMy WebLinkAboutMortgage_Chitwood �:a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
`�-T-r FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/609)
; Piesmbed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
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To be filed in person or by mail with the County Auditor or County Recorder of the county where e 'I .
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 pvelyy%2)months ❑ County Recorder
before March 31 of each year the deduction is sought - F C Ii -(r 2015
See reverse side for additional instructions and Appector burro/ / �
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Assessed value areal prop
Mortgage/Contract Indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appIrant the sole
Mardi 1:amnt year March 1,current year ,1 date of apprica owner?
tlon legal or equitable own
7Qr ,cp(� . OV ❑ Yes ID No
If no,what is his/her exact share of interest? If owned with someone other than spore,indicate with whom
If name on record is different than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller fl�t f
Address of mortgagee or contract seller(number and street city,sate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,nit):state,and ZIP code)
Does applicant own property in any other If yes.what county? • What Taring Dishict? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for anent year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved/ink the amount of:-
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20_ Ode
_I . :AN\ / () 1 r.�- _ 20 20 20
Signature of Co 1•�.�.((,.�r`�v=-L.tM.- County Date(month.day.year)
I I We certif. 15- 451 laton is true and correct and that the applicant is a resident of Indiana and
owner I con filed.
Slgrahn vne i Date(month,day,year)
plan 1jz/za<;
tr- ern o(ap (numbara sties;aty,state,and ZIP code) .
authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sloes;d0:state,and ZIP code)