HomeMy WebLinkAboutMortgage_Alstatti�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i�'�/ FOR DEDUCTION FROM ASSESSED VALUATION S`P Year
":�", State Form 43709 (R6 / 5-06)
,� Presaibed by DepaNnent of Loral Gwemment Finance
M
INSTRUCTIONS: � File,M�
To be frled in person or by mail with the County Auditor of the county whe�e the property is located. c� `�
Filing Dates: iJ Real P�operty: Dunng the 72 months before June 11 of the year the deduction is fo be effecti Co N7Y AUD�T�R
2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the y���educ�on is to be elfective.
See reverse srde for additional instructions and qualifications.
Appiicant
Taxing Dislrid
buyer_ see r�trictio� on ieverse �ide)
/ legal description
number
Page number
/�/"''�/' ` 'Ol0 Gz �C.iL� /
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
MarcF� 1, current year March 1, wrrent year owneR ❑ Yes ❑ No
✓ I rlJ!/V
what is his / her exad share of interest?
If name on record is dif(erent
of mortgagee or contrad seller
Address of mortgagee or conVact seller (number
Name of assignee or other owner or holder of
If owned with someone other than spouse, indicate with whom.
indicate below:
street�ty, state, ZIP
S
Address of assignee (numberand street, city, state, ZIP
Dces applicant own property in any other If yes, what county?
county in Indiana?
Is the property in question:
❑ Reai Property ❑ Mobile Home pC fr1.1-�
Dra���er NO..��.7.......
What Taxing -'
COUNTY AUDITOR
)edudion approved in the amount of:
20� 20�� 20 20
P P �'�e
Signature
County Auditor
20
C1r(� �'�. .....�' 1��.
.........
�9.�i�d 9�.�,t,�'��„�
20
Date
20
certity under ihe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
`Ent of Indiana and owner of the aforemenlioned property on March 7, 20
(ull name)
��, c .
ss ot aoolipnt
l'
Person authorized by duly executed Power of Attomey
o� by ic s-,.,_,2-.0�
person