HomeMy WebLinkAboutMortgage_Dierlamrt�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�`~ � FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S�y State form 43709 (R4 / 10.01)
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Prescribed by Department ol Local Govemmen[ Finance
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INSTRUCTIONS: File Mark� ��
To be filed in person or by mail with the County Auditor o( the county where the property is located. _� ;� �#�,
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 0l the year the deduction is to be eR�'ve � 3--� '
2) Mobile Homes assessed under IC 6-1J-7: Behveen January 15 and March 31 0l the year the deduction is ��ULeffective.
See reverse side /or addifional instiuctions and quali�cations. F E B O L
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Applicari (� ner or contracf buyer - see restncti ns on reverse side) IwZ� .,-,�=��
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Taxing ' rid Key number / legal description Record number D/
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Assessed value of real prope as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year owne(? 0 Yes ❑ No
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If no, whal is his / her exact share of inlerest? If owned with someone olher than spouse, indicate with whom.
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If name on record is different ihan that of applicant, indicate below: Is the property in question:
❑ Real Propeiiy ❑ Mobile Home QC 61.1-�
� e of moAgagee or contrad seller� � ,
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Address of mortgagee or contrad seller (number and street, city, state, ZIP J L��
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Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own propeRy in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent year?� YesO No
COUNTY AUDITOR
Deduction approved in the amount of: � 1/ ,
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9i� ture County Auditor Date
We certify under the penalty of perjury thai the above and foregoing information is true and corred and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Sign e(owners full name) Person authorized by duly executed Power of Attomey
/l or by IC 6-1.1-12-.07
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II si ent addre s of applicant Address of authorized person
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