HomeMy WebLinkAboutMortgage_Woodruff 'a STATEMENT OF MORT*E OR CONTRACT INDEBTEDNESS® County I Township I Year I
'*= FOR DEDUCTION FROM ASSESSED VALUATION
r_ ` State Form 43709(R1;/6-09) ��II''''��
4.,. ° Prescribed by 709(R Deparanent of Local Government Finance I 1E
INSTRUCTIONS j�Eo UMaric
To be filed in person or by mail. I l�ICI �-A 20I U rm filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is AP,h.:`
Must be filed with the County Auditor or County Recorder of the county where the property is located ❑ County Auditor
on or before January 5 of the immediately succeeding calendar year. County Recorder
•2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Aut
county where the property is located during the twelve(12)months before March 31.-of a V"eC34flJTY AUDITOR
deduction is sought.
See reverse side for additional instructions and qualifications.
App er or can el r-ss,e'A n rse '' )
M- W�
Taxing D¢mc Key number/legal desc ecc num I Page number
3(6-I3 do-10/ -Goo./ D-OD5 dip /224 i(volu ; tS3
Assessed value of real proolty as of I Mortgage/Contac indebtedness unpaid as of Mortgage I Con a indebtedness unsaid as of Is the apycant the sole
Mardi 1,cement year March 1 current year ca e,0 3dpGrayt�� legal oreca ble ow er?
If no,dicer is nis/her exact snare of interest? I If owned with someone other than spouse,indicate with wham •
If name on record is different than that of apolont,indicate below. ,Iss—the properly in ouestion:Annually Assessed
yree
L al Property ❑AnnuallyAsseccer
Name rt agee contract seller
Mobile Home(IC e:1.1-7)
��� ;brae 7 • ,,
Andress of m agee or contract seller un.umber and street,/Cny,sa(�,a ZIP )
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,sate,and ZIP code)
Does applicant own property in any other If yes,what county? I What Taring District? Has this deduction been requested on property
moray in Indiana?
❑ Yes No . for ctrrent year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of: -
20 20 20 20 20 20 20
Signature of County Auditor County I Date(month,day,year)
I I We certify under the penalty of perjury that the above and forecoing information is true and correct and that the applicant is a resident of Indiana and
owner I contras buyer of the aforementioned property on date application is filed.
Sigbiota re o s full e) I Date(month,day year)
ruA,(esicpnt a ar of a li t(numb �d ste/y/-ify,state.and code
,///�/ (�`
Person
Person ho vm by guy Power of/ ome! indite C�'W /N C fV ( 9 .
Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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