HomeMy WebLinkAboutMortgage_Morgan (4)�e' ^�n
;ei t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
��i�' FOR DEDUCTION FROM ASSESSED VALUATION
i'+ State Fortn 43709 (R6 / 5-OG) . . . . . . .
�• Presoibed by Department o'. Local Gwemment Finance � -
INSTRUCTIONS:
To be tiled in person o� by mail with the County Audito� oI the county whe�e the prope�ty is
Filing Dates: 1) Real Property: During the 12 months before June I f of the year the deductlon is lo be glJ�r,tjve. 7
2).Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ye�7� Y deddc '(roir'is to be effective.
See reverse side for additional instn�ctions and qualifrcations. �„ „ �
Applicant(ownerorp nfracfbuyer-see
Taxing Distrid
Assessed value of real property as of
March t, current year
no, what is his / her exad share of interest7
reverse side)
ICb�numbe�Y legal description Record number � Q0 �
ab-a�_09-l00-000.s y--�X�/ef 733/
MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenl year owneft ❑ Yes ❑ No
�� v�
If owned wilh someone ather than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�me of mortgagee or contrad seller
� � � �
Address of mortgagee or contracfsefier (number and st2et, city, sfate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sVeet, city, state, ZIP code)
Does applicant own property in any olher I If yes, what county?
county in Indiana?
Deduclion approved in the amount
20 �$ 20
P
Signature
��
❑ Real
❑ Mod7e Harne pC 61.
�pJ►iry� �� � � I-o7-oj
`�/ 0 �� 000. ° o
. �Ct�/,�/
What 7 (J ested on
Yes ❑ No
��i� ( — �7 / at�n�
COUNTY AUDITOR
of:
20 20 20
��
County Auditor
20
20
We certify under the penalty of perjury that the above and foregoing infortnation is lrue and corred and that the applicants was / were
resideni of Indiana and owner of the aforemenlioned propeRy on March 1, 20
�nature (owners full name) Person authorized by duly executed Power of Attomey -
�. 1 e. _ h., ,..._..__� o� by ic s-�.i-iz-.o�
ryun resiaenc aaargss or appucant Address of authorized person
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