HomeMy WebLinkAboutMortgage_Batey%� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION �P Year
'�J • State Form 43709 (R6 / 5-OG) +
� Presaibed by Depanment ot Local Govemment Finance
FEB
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditoi o( the county whe�e the p�opeRy is located. ��p-y'��a�. ,Q
Filing Dates: 1) Real Property: DuAng the 12 months before June 11 of the year the deduction is to be elte�tive. R
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 dd��9��r���i/���'c�%��TsAto be eflective.
See reverse side for additional instructions and qual�caUons.
Applicant (owner or contracf b er - see restrictions on reverse side)
Taxing Distrid Key number / legal d iption Record number Q
� � /�_ ^ `� Page number � �
/ OC
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March 1, cunent year owne(? ❑ Yes ❑ No
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If no, what is his / her exad share of interesl? If owned with someone other lhan spouse, indicate with whom.
. 0 -
If name on record is difterent than ihat af applicanl, indicate below: Is the roperty in question:
� Real Property ❑ M�ile Home QC 61.1-�
e of mortgagee or contrad seller y
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Address of mortgagee or conVact :
Name of assignee or other owner �
Address of assignee (num6er an
Does applipnt own property in ai iis dedudion been requested on
county in Indiana? rty for current year? O Yes O No
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DeducGon approved in the amour�...�. --
20 �_ 20 �_ 20 20 20 20 20
P P � ��,�'
Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was l were
:sident of Indiana and owner of lhe aforementioned property on March 1, 20
' natur (owne/s (ufl name) Person authorized by duly exewted Power of Attomey
� or by IC 6-1.1-12-.07
F I resi ent address of applicant Address of authorized person
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