HomeMy WebLinkAboutMortgage_Bass� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
` FOR DEDUCTION FROM ASSESSED VALUATION
�s �� �/ State Fortn 43709 (RS I 4-03)
Presaibe0 Dy Departmeni of Local Govemment Finance
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Year
INSTRUCTIONS: � � � 'File Madt/ �i�
To 6e filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to be eNecti�i,Q; (j � 8 Z�Q3
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ye///ar'''���the deduction i/s �to 6e eflective.
See reverse side for additional insVuctions and qualifications. / j �/ J y� ��
� / .-� �-. 15�.��.r.� �7��-
/ C:BSON COJtvTI' AUDI;C., I
Assesseil value of real property as of
March 1, currenl year
If no,
exact share ot interesl?
side)
Key nurtiber/legal
Record number
/1 1 0 _/.r� '1 l` M I Page number
cibt �.a_v o�-c_�.�
MoAgage / Contrad ir
March 1, current year
O �
�S
as of I Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
If owned wilh someone other than spouse, indicate with whom.
If name on rewrd is different than that of applicant, indicate betow:
�me of mortgagee or contrad seller
G
Address of mortgagee or contrad selier (number and street, city, state,
Name of assignee or other owner or holder of mortgage
Address of assigr Q 7_ s^S,
Drawer i\'0....•�..........7�
Does applicant rn _ •
county in Indiana Card 1�'Q,
.....................
Deduction approved in lhe amounf of:
20 oK I 20
P9�ABoA
Signature
2� I 20
County Auditor
What Taxing District?
Y AUDITOR
� 20 h
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s the property in questfon:
❑ Real Property ❑ Mobile Home QC 61.1
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Has lhis dedudion been requesletl on
property for current year? � Yes � No
20
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' We certiy under lhe penalty of perjury that the above and foregoing infortnation is true and correcl and thal lhe applicants was / were
resident 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
address of applipnt �76 �3 IAddress of authorized person