HomeMy WebLinkAboutMortgage_Lanham r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County�q rEhir'Dr
n;; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Lad Government Finance
INS7RUC71ONS: II I.: I - .
Form filed with:
Tb be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought ;en . • •
2) Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months ,..• -7�, �r
before March 31 of each year the deduction is sought - GIBS 4 N a UN t . •
-
Appecant( contract buyer/re-See reverse side for additional instructions and qualifications. �� ,,��
T 0' (��(�U�' Key n,nmert legal CCC don Record number Page numbPi
J /1600i 6 7 oar? °Ter/* dJ Assessed value of nil property as of ra.t_Og. ..f0/._
ortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1:orient year arch 1,cortent year date of appfimtbrx � / legal«equitable owndl
iD-, 6 VO ❑ Yes ❑ No
lino,what is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record is different than that of app&ant Indicate below. Is property in question:Annually Assessed
Real Property ❑Amwauywssessed
Mobile Home(IC 6-1.1-7)
•
Name of mortgagee Or carted seller Cgi
Address of mortgagee or contract seller(number and save city-state, ZIP )
Name of assignee or other owner or holder of mortgage /1 / • /l`�on M��W/f-� d/
Address of assignee(number and street,city state,and LP code) \((/- �/1(l�� �!W/
Does applicant own property in any other If yes,what county? • What Taxing Disaict? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for Arent yeaR
❑ Yes ❑ No
COUNTY AUDITOR
Dedu(- .._____...,_ _ —_ _
?/OilleCfin• K 20 20 20 20
Siam County Date(month,Oar.year)
I 1 going information is true and correct and that the applicant is a resident of Indiana and
a...._.. ______.__.. ipl'ication is filed. .
XSignature( wnel t rye{ me) to^ Date(normx,day,year)
Full resident... of app ir t(number- •street airy,state and ZIP cod
Person authorized by duty executed Power of••• or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code) .