HomeMy WebLinkAboutMortgage_White`°rt�'�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
� FOR DEDUCTION FROM ASSESSED VALUATION
S ` / SUte Form 43709 (R4 / 10-01)
�r.
� Prescribe0 Dy Depanment of Local Govemmeni Finance
INSTRUCTIONS: ��
To 6e filed in person or by mail with the County Auditor of the county wheie the prope�ty is
Filing Dates: 1) Real Property: During the 12 months beloie May 11 0/ the yea� the deduction�is to tie ef( �.
� nn
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and Ma�ch 31 0l the year e deduction is to be effective.
See reverse side for additional instructions and qualificaGons. � /(� // �l
Applicant (owner confract buyer - se resfricUons on reverse sid
Taxing Distrid Key number g e
�W " �
Assessed value oi real property as of Mortgage / Contred ir
March 1, wrrent year March 1, current year
If no, what is his / her exad share of interest?
If name on record is different than that
�ame of mortgagee or contract seller
Address ot mortgagee or conVad seller
Record number D �
� /�� �� �page number
V Rla
as
�s me appucarn cne soie iegai or
ownef� ❑ Yes ❑ No
� V�J'
If owned with someone other than spouse, indicate with whom.
� -ao -os a o _ Qo�. �39-0� i
indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.
�
and street, city. state, ZIP
Name of assignee or olher owner or holder of mortgage
(number and st2et, city, state, ZIP code)
Does applicant own property in any olher Ii yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year?� Yes❑ No
Deduction approved in the amount of:
20 D� 20 @� 20
Signature
COUNTY AUDITOR
20
County Auditor
% f�l 20 V� 20 �� 20 0 j
� P � P
Date
We certify under the penalty of peryury that the above and foregoing infortnation is true and corred and lhat the applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
applicanl _ _ �Address of aulhorized person