HomeMy WebLinkAboutMortgage_BeanSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
` � State Form 43709 (R3 / 10.00)
-� Presrnbed Dy State Board of Ta�c Commissioners
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InsWctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 72 months before May 11 of the year the deduction is to be effedive. See
reverse side for additional insWdions and qualficafions.
FORM 5
Coun Townshi Year
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AUG 1 2001
File Mark
CIE�O� COtI?:TY fiUDITQR
Applicant (ownerorconhact buy r- e re 'ctions on 2v e side) �.
Ta�cing Distrid Key number / legal d ption Record number
Q `D � Page number �
Auessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March t, wrrent year owne(? ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
� . - o- 000. - 93 -66/
If name on record is diflerent than that of applicant, indicate below:
e of mortgagee or contract seller �
� 3
Address of mortgagee ar contrad seller (number and stieet, city, state, ZIP
Name of assignee or otFier owner or holder of mortgage
Address of assignee (number and street, dty, state, ZIP code)
Does applipnt own real property in any If yes, what counly? What Taxing Distrid? Has this dedudion been requested on
other county in Indiana? property for current yeaR � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �C.' 20 � 20 Q�� 20 20 z_ 20 �Z 20 �� �
5 P1�e � � P
Sign re County AudRor Date
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I/ We certify under the p nalty of perjury that the above and foregoing information is true and corred and that the appiicants was / were
ident of Indiana and owner of the atorementioned property on March 1, 20
Si na re (owner (ull me) Person authorized by duly executed Power of Attomey
� or by IC 61.1-12-.07
ull ident dress of applipnt Address of author¢ed person