HomeMy WebLinkAboutMortgage_Lantaff (2)rt�" STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
- ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�, - / State Form 43709 (R4 / 10.01) .
��u
� PrescriDed by Deparimenl ol Local Govemment Finance 7 � g � .
i�
� � � . t�.
iNSrRUCrioNS: ��N� ,� �;ie�Mark
To 6e filed in person or by mail with the County Auditor of the county where the propeRy is located. UU�
Filing Dates: 1) Real Property: During the 12 months 6elore May 11 of the year the deduction is to�be ef/ective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 o/tlie year the d�educfmn is to�"b�e �e//%ctive.
See reverse side for additional instiuctions and qualifications. GI3�S�0����1��4 � O�R"j
�
Applicant (owne� or contract 6uyer �strictions on reverse side
L(%�d.D °E'
Taxing Districf �� ^ T �� Key number / legal description cord number
� <.r.t.c.ot.. o o �- o, o s3 -� a- 9 la 5 �/
O/ 5-
O �Q 5 a Page number
Assessed value of real o erty as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
�
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate wilh whom.
-�U- - �3-66/.D$3-66/
If name on record is different than that of applicant, indicate below: Is the properiy in question:
Property ❑ Mobile Home QC 61.1-�
�ame of mortgagee or contrad seller � ^
0
/..J
Address of mortgagee or conVact seller (number and stieet, city, state, ZIP _� � �J
� /
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent yea(? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amouni of:
Zo a� za o� zo D zo zo � zo � 8 za �
� P P
Signalure County Auditor Date
I/ We certiy under lhe penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owner's full name) Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
Full resident address of appliqnt �--- Address of authorized person