HomeMy WebLinkAboutMortgage_Dix (3) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/5-09) II,E D
Prescribed by Department of Local al Government Femme
INSTRUCTIONS: v .
Fmp1 C u y Au
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. rho
Filing Dates: 1) Real Popery:Must file during the year for which the deduction is sought County M Ito/
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
.-fore March 31 of each year the deduction is sought - -Co tY �er
See reversesid- • additional ins and qualifications. GIBS NCOUNTYAUDITUtt
Applicant • arcan buyer- on reverse site)
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Taxing 7.r •4t-oeN rd/legal description/ leQ czoor /4 7 - Dd / l//V/S Pia n 6
• r�_•value of reall�Lr/oopeerty as of Mort gage/Contract indebtedness unpaid as of Mortgage I Conead'eMebtedness unpaid as of Is the applicant the sole
- 1;one year March 1,anent year date ct appficatm //,'/) legal or equitable owner?
/39 WV ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than cpu4A,indicate with whom
If name on record is different than that of app&cant,Indicate below. Is property in question:Annually Assessed
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Property ❑MnuallyAssessed
• //taid�St tidied
ied r���iiiii Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r
Address of mortgagee or contract seller(number and street,city. te,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,date,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana? parent❑ Yes ❑ No for rent year? ❑ Yes ❑ No
COUNTY AUDITOR
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Sic County Date(month,day,year)
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J Cts„A C 1J ti_vk mooing information is true and correct and that the applicant is a resident of Indiana and
D-3- IS application is filed.
Wre(owners nm namerl,L� / Date(month,day,year)
F dent of pplicant(number and sheet,oTy,state,and ZIP code)
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Person authored by duly executed Power of Attorney 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)