HomeMy WebLinkAboutMortgage_Bise (2) � .,- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°" ▪ i FOR DEDUCTION FROM ASSESSED VALUATION
i' ``' .• State Form 43709(R13/10-15) IB56Al, .,t
• Prescribed by Department of Local Government Finance F
INSTRUCTIONS: Vile Mark
To be filed in person or by maiL Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction t.
Must be filed or postmarked with the County Auditor or County Recorder of the county wh to rce?9?O pCountY Auditor
located 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 A i or of th cou
where the property is located during the twelve(12)months before March 31 of each year t ght.
See reverse side for additional instructions and qualifications. G 18 S O N COUNTY I !T rJ R
Applicant owy j ntract uye see restrictions on reverse side)
Ta Ark Dist• Key number/legal description Reco number Pa number
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Assessed value of real grope s of Mortgage tract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current ye assessm current year� date of application legal or equitable owner?
ll
8 O `1 ❑ 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
53
Address of mortgagee or contract seller(number and street,city,state,an ZIP code)
Name of assignee or other owner or holder of mortgage
b..r526 'Ro5c-KA
/Vhat Taxing District? Has this deduction been requested If yes,state amount of deduction
on prrent yrtyea?
AOcurrent yearf or ❑YeS ❑NO
;a balance on the person's mortgage or contract indebtedness that is recorded in the county
i.recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
20 I 20 20 20 20 20 20
Sig -turemy u 'or CountyIIDate(mo h, ay, e4 �1r41 • —� -aasb
I/We certify under the penalty of perjury that the ab an going information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(o ri'e s fu name) Date(month,day,year)
Xj.r.,......:
Full r ide dd ss applicant(nfimber and street,ci ,state,and ZIP . ,
code)
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Person lagprized by duly executed Power of Attorney or by C 6-1.1-12-0.7 si/, - 7 J y9 - (7,5G Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) `7`
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