HomeMy WebLinkAboutMortgage_Hodgen`° R�'� .'STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
n-'" : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S�� y State Form 43709 (Ra / 10-Ot)
�� Prescribed by Department of Loral Govemment Finance �
J
INSTRUCTIONS:
To 6e �led in person or by mail with the County Auditor o! the county where the property is
Filing Dates: 1) Real Property: Dunng the 12 mont6s 6e%re May 11 of the year the deducti
2) Mobile Homes assessed unde� IC 6-1.1-7: Behveen January 15 and March
See reverse side lor additional inst�uctions and qualificafions. ��
buyer-see
Taxing
Assessed �/alue of real pr�rty as of
March 1, current year
If no, what is his / her exact share of interest?
If name on record is different than Ihat of
of mortgagee or contract
Address ot mortgagee or conhad seller
on rev,grse side)
�AK 1 2 ��vtark
to be
Y f1j71
1L
i
Key number / legal description Recor�(�Gm e (�
-pod -
O/ c` !�Q Oa 7� Page number
J
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curreni year ownef? ❑ Yes ❑ No
��Q��
Ii owned with someone other than spouse, indicate with whom.
below:
and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, stafe, ZIP code)
Does applicant own property in any olher ( If yes, what county? What Taxing Distrid?
wunty in Indiana?
Deduction approved in the amount of:
20
Signature
20
.. .�,.
COUNTY AUDITOR
20� 20�
� �
County Auditor
20
s the property in question:
❑ Real Property ❑ Mobile Home QC 61.
- �.3
Has this dedudion been requested on
property for current yeart �] Yes � No
20 �� 20
P
Dale
1���� �
certify under the penalty of perjury that the above and foregoing information is true and correct and thal lhe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ire (owners full name) , Person authonzed by duty executed Power of Attomey
;:� _ , L _ . . Q _ d . . _ , or by IC 6-1.t-12-.07
applicant �Address of authorized person