HomeMy WebLinkAboutMortgage_French (3)e�fx�° STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
y'*---. ': Count Township Year
cf . POR DEDUCTION FROM ASSESSED VALUATION
�; �y StateForm43709(R4I7P01) �� i � �, ,� � �
�� � Prescribed by DeOanmenl of Local Govemment Finance � �� �� �
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�NSrRUCr�oNS: DEC 10,��q�ark
To be (led in person or by mail wifh the County Auditor o/ the county where the propeRy is located.
Filing Dates: 1) Real Property: Dunng the 12 months beto2 May 11 olthe year the deduction is to be ef(ective. �� � ��
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 otthe•yearthe�deduction�is-to-6e e8ective.
�o G:�3S0+1 COL?!i Y r.UD:TCa .
See reverse side !or additional ins6uctions and qualifications.
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or contract buyer - see �estnctions on reverse side)
Taxing
,Sovrr e r v; ( �e
Assessed value of real property as of
March 1, current year
If no, whai is his / her exact share of interest?
Key number / legal description
,
Recortl number
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D2b -Qp � 37^OQ Page number
Mortgage / ContraG indebtedness unpaid as of Is the appiicant the e legal or equitat
March 1, current year ownef? es ❑ No
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name on record is different fhan that of applicant, indicate
of mortgagee or contract seiter
Address of�hortgagee or contrad seller
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Name of assignee or other ow r or hol
D00, oa
If owned with someone olher than spouse, indicafe with whom.
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and street, city, state, ZIP
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mortgage
Address of assignee (numberand st2et, city, state,
Isthe property
❑ Real Property ❑ Modle Home QC 61.1
Does applicant own property in any other I I( yes, what county? I What Taxing Distnct? Has this deduction been requestea or
county in Indiana? property for current year?� Yes� N
Deduction approved in the amount of:
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Signature
COUNTY AUDITOR
20 � 20 20
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Couniy Auditor
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Date
20
I We ceRify under the penalty of perjury that the above and foregoing information is We and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March t, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07 .
, Full resident address of '�p�licant � r ^ IAddress of authorized person
1