HomeMy WebLinkAboutMortgage_Fuhs (2)�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
's / State Fwm 43709 (R5l 4-03)
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� PrescriEed by DepaMient of Local Govemment Finance �j 9� � � �
� � 1�/ �J �
INSTRUCTIONS: �UL F�e4 2003
To 6e filed in person or by mail with [he County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months befo2 May 11 of the year the deduction is to 6e eHecfive. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ fhe year the deduct Jn�is to be �t�e.
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See reverse side Ior additional instructions and qualifiwtions. ��:?i3SprJ C"r�U��l i 1' AUDITOR �
-- ofG -�?� -/�- 7ao - O al 7 S�3 -G�l.
Taxing
(owner or contract buyer - see resfrictions on reverse
�I � /1 n , n . f�
Key num�er / legal description
... � `
Assessed value of real property as of Mortgage /� trad indebtedr
March 1, current year March 1(�nt year
.��9� �O�
ll%
If no, what is his / her exact share of interest? If owned
If name on record is different than that ot applicant, indicate below:
of mortgagee or contraIX seller
Address of mortgagee or contrad selier (number
of assignee or other owner or holder of mortgage
of assignee (num6erand street,
Does applipnt own property in any
county in Indiana?
Deduction
20
in the mounf of:
,�,9�
3
=t, city, state, ZIP
state, ZIP code)
If yes, what county?
Record
IPage
.- r�l�
unpaid as of Is the applican t� he sole legal or
owneR �es ❑ No
other than spouse, indicate with whom.
❑ Modle Hane (IC 61.
DrawerNO..j.�,�;' �S %/
.. Card NO . .....................
Wha, � �.,...y _._...__. sted on
� property for wrrent yeaf? LJ Yes ❑ No
COUNTY AUDITOR
2� %� 2� 2�� 2� 0� 20
`tP P Q
County Auditor Dale
We ceAify under the penaity of perjury that the above and foregoing iniormation is true and corred and that the applicants was / were
�esideni of Indiana and owner of the aforementioned propeRy on March 1, 20
Person authorized by duly executed Power of Attomey
or by1C 6-1.1-12-.07
authorized person