HomeMy WebLinkAboutMortgage_GravesSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Co n T ip Year
�. ♦ SMte Form 43709 (RS / 4-03)
� � PrescriDeO by Departmem of Lacel Gtivemment Finarice
JAN 0 9
INSTRUCTIONS: Fite Mark
To 6e filed in person or 6y mail with the County Audito� oI the county where the property is located. ��
Filing Dates: 1) Rea/ Pr�perty. During the 12 months be%re May 11 0/ the year the deduction is to be'��e.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of G1��t� �O�rYcH�liJA���e effective.
See reverse side (or additional instructions and qualfications.
Applica (ownerorcontract buy,e5- see stricfions on reve e side)
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Taxing Distrid Key number /legal description Record numbeo �_�� �
Page number
o� a -ao i8.3 - �
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applica t the sole legal or equitable
March 1, current year March 1, current year ownef? �es ❑ No
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16 no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diflerent than that of appliwnt, indicate below: Is the property in question:
eal Properiy ❑ Mobile Home QC fr1.1-�
�me of mortgagee or conVact seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
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Name of assignee or other awner or holder of mortgage �� n�� r M„��
fY W <..CJ�r
Address of assignee (number and st2et, city, state, ZIP crode) '� t' ��""' "
Dces applicant own property in any other If yes, what county? \ �V ���� � requested on
county in Indiana? ? � Yes� No
�D�. G _ COUNTY AUDITOR d,�
Deduction approved in the amount of:
20 20� 20�� 20 20 20 20
� j 1
Signature I County Auditor Date
1 ��
� We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Signature (owners lull name) Person authorized by duly executed Power of Atlomey
� or by IC 6-1.1-12-.07
Full resident address of applipnt Address of aulhorized person
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