HomeMy WebLinkAboutMortgage_Austillrt�° 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' t FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S - � Siate Fofm 43709 (R4 / 1407 ) �
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� PrescribeO by DeDaM�ent of Local Govemment Finance '� '� � � "
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INSTRUCTIONS: Fije M�7rk
To be filed in person or by mail with the County Auditor o/ the county where the property is located. 0 �T i U 10UL
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ the year the deducfion is t e ef(ective. �
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 0/ fne year e dedu�tion i�effective.
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See reverse srde (or additional instructions and qualifrcations. �" G!BSOfI COU�!TY AU�i?OA .
Applicant (ownerorc ntract buyer- see restricfions o verse side
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Taxing Distrid Ke number / legal description Record number
������- "- �� ��(� �S �/ � 0��1' Page number ��� r
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, curtent year owne(? ❑ Yes ❑ No
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If no, what is his / her exact share of inlerest? If owned with someone other than spouse, indicate with whom.
If name on record is different Ihan thai of applicanl, indicate below: Is the propeRy in queslion:
❑ Real Property ❑ Mobile Home pC 61.1-�
�ame of mortgagee or contract seller
Address of mortgagee or contract seller (number and street, ciry, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand stieet, ciry, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for wrtent yea(?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 Q�_ 20 � 20 20 20 �� 20
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Signature County Aud' or Date
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I/ We certify under the penalty of perj ry that the above and foregoing informalion is true and corred and ihat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
.�Si t (owne lull name) Person authorized by duly executed Power o( Attorney
or by IC 6-1.1-12-.07
11 esi ent d ss of applipnt Address of aulhorized person -
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