HomeMy WebLinkAboutMortgage_Sandefur� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
�' FOR DEDUCTION FROM ASSESSED VALUATION
State Fwrt:43709 (R514�3)
�! �� P25ai0ed by Departmem ot loral Govemment Finance
Coun Township Year
�
JUL 1 S 2005
INSTRUCTIONS: File Mark
To 6e filed in person or by mail with the County Auditor ol the county where the property is located.
Filing Dates: �1) Real Property: During the 12 months befo2 May 11 0/ the year the deduction is to be eflectiye�d �
2) Mo6ile Homes assessed under IC 6-7J-7: Between January 15 and March 2 o/the yea�r����c�`C� t���ctive.
See 2verse side for additional instructions and qualifications.
Applicant (owner or cont�act buyer - see
Taxing Distrid
`�-JG�UG(UT1
Assessed value of real property as of
March 1, current year
If no, what is his / her
name on record is different
of mortgagee or'contraU
of mortgagee or contrad
interest?
on reverse
number /
Record
Page number
— U-1 'YJ
Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? L�'es ❑ No
,�ac��
Ii owned wifh someone other than spouse, indicate with whom.
lhat of applicant, indicate below:
stieet, city, state, ZIP
Name of assignee or other owner or hoider of mortgage
- QO-DOO. `�d�-GC'�/
Is the property in question:
❑�al PropeAy p Mobile Hane (IC 61.
Address of assignee (number and st�ef, city, state, ZIP code) Drawer NO ...................
Does appliwnt own property in any other If yes, what county? Card NO. D S-�� �cp
.....................
counry in Indiana?
,�/, , 3_ Q �� COUNTY Auui i un
_L.y� c� � '
Deduction approved in the amount of:
20 20 20 �
� P P
Signature
�
20 _ I 20
County Auditor
20
Date
=en requested on
�ear? � Yes ❑ No
20
� We certify under the penalty of perjury that the above and foregoing information is we and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by
or by IC 6-1.1-12-.07
Fuil resident ad�+�ss oTapplicant IAddress of authorized person