HomeMy WebLinkAboutMortgage_AllenSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
S / Siata Form 43709 (RS / 4-03) �
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` PresaiEad by DepaMiem of Local Gtivemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the Counry Auditor of the county wAere the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months befae May 11 of the year the deduction is to �eotiv�. ��4
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year tlie deduction is to be eflective.
See reverse side for additional instructions and qualifrcations. / • , /
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' GIBSON C':._ .
or
e
Assessed value of real property as of
March 1, artent year
If no, what is his / her exact share of interest?
name on record is diHerent than Ihat
of mortgagee or contract seller
on reverse
Key number / legal description
�Z•y��t� �n��ls�•7�
I- .. .-
Page number '
� Q ' — Q �, ' �
Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtent year ownen �Yes ❑ No
ya so�
If owned with someone other than spouse, indicate with whom.
indicate below:
Address of rtiortgagee or conVad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Tazing Distric[?
county in Indiana? �
(
�� � � y _ �_ .S� COUNTY AUDITOR ` r
Uetluctlon approved in the amount ot:
20� 20 20
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Signature _
��7:��
1.
County Auditor
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f�
s the property
o�i �
❑ Mobile Home pC 61.1-�
Has this dedudion been requested on
property for current yeaR � Yes ❑ No
20
20
certify under the penalty of perjury that the above and foregoing iriformation is true and corred and that�the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ire ��� me� Per� n authorized by dury executed Power ofAttomey
,e . � or b IC 6-1.1-12-.07 � .
�c/
ot appliqnt
0
Address ofauthorized person
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