HomeMy WebLinkAboutMortgage_Williams (9) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
b'f'�;' FOR DEDUCTION FROM ASSESSED VALUATION
"v• State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: F PM J 13 .
Tb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is local
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought 9 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - MAR lib 20.3Y Recorder
•
See reverse side/far additional instructions and qualifications. u ( //tI '1/(�
ADPf tor V't a mtt1ZiI!�rc.L.�rr4 f" 't'��QT1""r 'r�
Taxing DlsUi z rl= pton Coi BI I 1 TY 1 (1 5
Assessed value cif real property as of Mortgage/Contact Indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Malt 1;current year March 1.cement year date d f appripl on legal or equitable owner?
1/p_ Y ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,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 / A
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assgnee(number and street city,state,and ZIP code) 14- L17 (5
Does applicant own property in any other If yes,what county? • L t property_
county in Indiana?
❑ Yes ❑ No ❑ No
COUNTY AUDITOR
Deduction approved in the amount at
20 _ 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,year)
I I We - 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
own, con:.ct buyer of th mentioned pro rty date application is filed. .
/ / /(-`•/ Data(month,day,year)
if
F•t t ac'/ s of app!(num/heralyyate,and TJ� emQ y ^ 4 1 G 1, O
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 ail Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)