HomeMy WebLinkAboutMortgage_Stewart (4) narb STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year
t..___:. FOR DEDUCTION FROM ASSESSED VALUATION
L State Form 43709(R71/6-09) - t� (/,,, 2016
Prescribed by Department of Local Government Finance -
INSTRUCTIONS: 1 arc
To be filed in person or by mail. JUN y A� 9 201„Form filed with:
Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the proper?. located El 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 thaL7Lgwos i I.•- •Tyr: .i
county where the property is located during the twelve(12)months before March 37 0 -.aerta
deduction is sought. ' i Avon-
OR
See reverse side for additional instructions and qualifications.
Appli t caner 4r ntract r-see restrictions on reverse side)
a/ � feCUQr7'
Tani Dispel Key number/legal description Record number Page number
atoKa ao -//- 4 /-ate cb�, ��� oa7 ao \� aago
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mar 1,a ntt year �/� Mayynh 1,,c/u/gent�yeaarr sidle of application legal or equitable owner?
7/a0 000. r / T/ 50-6 g.S ip-A coo, ❑ Yes ❑ No
If no.what is his I 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 a property in question:Annually Assessed
Real Property ❑Annually Assessed
CT
Mobile Home(IC 6-1.1-7)
Name oiffiaggagee or contracctt?Her ,
i-/ rsf iAQlio, a-/1324 L al A rm/
Address of mortgagee o trap seller umbers et.city,state,and ZIP code)
AQl din
rm, ZZ Coesa/
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
ElYes No
Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20_ 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify 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
owner I contract buyer of the aforementioned property on date application is filed.
Signature(ow e s Aril ) I I Date(month,day year)
X r o(y 6- ,- / to
Full resident address of applicant(number and street,city,state,and ZIP code)
Person authorized by duly executed Power of Attomey 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)