HomeMy WebLinkAboutMortgage_Siekman (2)� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
� .'. � Slate Form 43709 (R4 / 10.01) - - � . " ' 1 1 j '� ��. I
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Prescribe0 DeDartmenl ol Local Govemment Finance
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INSTRUCTIONS: DEC 1FrIeMa�
To be filed in person or by mail with fhe County Auditor of fhe county whe2 the property is located. �,
Filing Dates: 1) Real PropeRy: Dunng the 12 months belore May 11 0/ tbe year the deduction is to be eflective. � � � i (%
2) Mo6ile Homes essessed under IC 6-1.1-7: Behveen January 15 and March 31 0l tiie,year th`e de"ductioo'is'to'be,eftective.
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See reverse side lor additional inst�uctions and qualifications.
(owner or contract buyer- see restrictions on reverse
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Assessed value of real property as of
March t, wrrent year
If no, what is his / her exact share of interest?
Key number / legal desaiption Recortl number 0 �/
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DD I� O n�/ ��DD Page number �
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Mortgage / Contrad indebtedness unpaid as of Is the applicant, �the �s le legal or equitabi�
March 1, cunenl year owneR ld'1'es ❑ No
' � 60 000, D�
If owned wilh someone other than spouse, indicate with whom.
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If name on record is diHerent than thai of applicanl, indicate below:
of moAgagee or contrad
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Address o( mortqacjee or
o( assignee or
andstreet, c�,�state, ZIP
mortgage
Address of assignee (numberand street, city, state, ZIP code)
s the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-;
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Does applicant own property in any other If yes, what county? Whal Taxing Dislrid? I Has this dedudion been requested on
county in Indiana? property for wrrent yea(? 0 Yes ❑ Nc
Deduction approved in the amount of:
20 O� 20 �
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I Signature �
COUNTY AUDITOR
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County Auditor
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20 � Y 20
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Date
I/ We certify under the penalty of perjury.thal the above and foregoing infortnation is true and wrred and that lhe applicanis was / were
a resident of indiana and owner of the aforementioned property on March 1, 20
iignature (owners full name) Person authorized by duly executed Power of Attomey
�y j/w� / , or by IC 6-1.1-12-.07 �
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address ot appliwnt �?6 � 3 IAddress oi authorized person
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