HomeMy WebLinkAboutMortgage_Haley�i A� STqTEMENT OF MORTGAGE OR CONTRACTINUEBTEDNE3�
'�+' �= FOR DEDUCTION FROM ASSESSED VALUATION
«. ! Stata Fdm 43709 (R6 / 5-06)
� Presaibed by Department of Local Govemment Finance
INSTRUCTIONS:
To 6e (iled in person or by mail with the County Audito� of the county where [he p�operty is
Filing Dates: 1) Real Properiy,- During the 12 months before ,lune I1 of the year the deduction is to 6e eti�qti�.� 9 Z���
2) Mobile Homes assessed under IC 6-1.1-7: Belween January 15 and March 2 o/the year �� e uct�on �s to be elfective.
See reverse side /or additional instrucfions and quali(rcations. �-yn �
o'`� �
� _ � � ..,ocnm rnI1NTY AlJD170R
nt (ownerorcont�t buyer- ee r�sMcfions on reverse sid��
✓ �. (
Distrid Key number / legal description
Record number 2 D O�
f/ -
lh��) �p- a2D -p; 3-�V �- DOQ o29/ - Page number ��� /
XJ
Assessed value M real property as of MoAgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curreM year March 1, current year ' � ownef? � Yes ❑ No
asood
If no, what is his / her exad share of interest?. If owned with someone other than spouse, indicate wilh whom.
If name on record is ditterent than ihat of applicant, indicate below:
of moAgagee w conUad seller
Address oi mortgagee or contrad seller (number and street, city, state, ZIP
Name of asaignee a other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
DeducGon approved in the amount ot:
20 _�
P
Signature _
20
�
What Taxing Distr.
COUNTY AUDITOR
20 20 20
\�
County Auditor
s the property in queslion:
❑ Real Propsty ❑ Mobile Home pC 61.1
. _ ao�.�.-.7g�i -
D�a"Qr�O ,
. •W" , �Q
.a� � �"���
Ca a�
�3 _��udion been requested on
property for wrrent year? � Yes � No
Ti7
Date
20
We certify under the penalty of perjury lhat the above and foregoing information is true and corred and ihat the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
ica��cn� auu�oaa v� ayM��b��� � r{aaress or autnonzea person
? 9 3 7�S' o � J-,� �o � a � �' �,�,� �� �.,� i��� Ce � 3