HomeMy WebLinkAboutMortgage_Bennett (4) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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: FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R71/6-09)
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Pnescobed by Department ment of Lo Government Finance �F
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INSTRUCTIONS:
Form filed with:
To be filed in person or by mail with the County Audi or or County Recorder of the county where the property is located. t,t y�n ' U
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought Y� I ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months n
before March 31 of each year the deduction is sought - ❑ Coun Recorder
See reverse side for additional instructions and qualifications. l
Ap. (owner or - triab ns onreverse-side) '!nS3N VOuNIY AUDITOR
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T- /Ishirl Key number/legal description Record number Page number
a6-i2-o7 - lot - odd- /09. o1-8 I,f aeilo
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1:anent year March 1,anent year date of application owner?
/ legal or equitable owne
If no,what is his/her exact share of inters t? If owned with someone��tttan spouse,indicate with whom ❑ Yes ❑ No
If name on record is afferent than that of applicant.indicate below Is the p enerty in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,/ 12
Address of mortgagee or contract seller(number and street,eity,state,and ZIP code)
• Name of assignee or other owner or holder of mortgage ///���
Addres<^r^^=—__._,,..,b,and Street city.state,and ZIP code), " - 02 5 pr
Does applicant own property in any odlhr 1 ii ta,what county? • What Taxing District? Has this deduction been requested an property
county in Indiaru? for anent year?
❑ No
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR — -_ I.
Deduction approved in the amount of
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20 20 20 20 20 n
Sig natu of Ca s
County Ator - County A n
II We certify under the penalty of perjury that the above and foregoing Information is true and L
owner I contract buyer of the aforementioned property on data application is filed. L
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nature(owner M l name) I Date(mormr,aay,year)
ard sbee4 oil%state,and ZIP code)54 Aux-€44- -P-/.4-17 6 7 d .
Person authorized by ay executed Power of Attorney or by IC 6-1.1-12-0.7 Date(north,day,year)
Address of authorized person (number and street city,state,and LP code)
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