HomeMy WebLinkAboutMortgage_Roos STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
iiiA. FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R11/6-09)
Prescribed by Deparunerd of Loral Government Finance
INSTRUCTIONS: E -
lb be tied in person or by mail with the CountyAuditor or County Recorder of the county where the properly is located. ////
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 twelve(12)months F'It,�uyl n,_�ns�
before March 31 of each year the deduction is sought EIM 24e774
See reverse side for additional instructions andcomfit' dons.
AppGnnt(owner .•buyer-see re side)esb )s R
Taxing District Key number/legal description ben Pa
V 3b- 300- 00a. ' q-oa4 RCO7 7 2
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,cured year Marcel 1,current year datnf i •V V✓ legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate vela whom
If name on record is different than that of apogean;indicate below: Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller W'tAti e i .4 t•
in
y,
Address of mortgagee or contract seller(number nd street,cd ` ,and LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,r
Does applicant own property in any other (9d/[„j Has this deduction been requested an property
county in Indiana? Drawer NO O VV11„ / for current year? ❑ Yes ❑ No
❑ Yes
Deduction approved in the amount orb Card N O. 5.9��
20_ 20 _- _- I 20 20
Signature of County Auditor County Date(month,day,year)
I I We rtify 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
I1 0,1,/contract buyer of the aforementioned property on date application is filed.
Y(o N9 naa/mffe) 7\ Date(rt ,day,yeah
ress of/�ppOranl(number and stree city, t (mon ,P cad. tJ Ch N Oat 441 !-�cu:2�, f17c 3 9
Person authorized 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 coda) .