HomeMy WebLinkAboutMortgage_Stuckey (3)' �`.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
Suta Fwm 43709 (RS / 4-03) .
P25cnDetl Dy Depanment of �aal Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county whe�e the property is
Filing Dates: 1) Real Property: During fhe 12 months befo2 May 11 01 the year the deduction is to be �i��. � ZQQ6
2J Mobile Homes assessed under IC 6-1.1 •7: Between January 15 and March 2 0( the ye�1 the deduction is to be e(/ective.
See reverse side foi additional instructions and qualifications. �Ia� �
�� � . ,.,.,�r,u coUNTY�DITOR
Applicant
Taxing Distrid � "'
Assessed value oi real property as of
March 1, cunent year
� number / legal de tion
baa-000 3-n�
Mortgage / Contred indebledness
March 1, wrrent year
�?S S Oc�
Record number
Page number
as of I Is the applicant the sole legal or
ownef? ❑ Yes ❑ No
If no, what is his / her exact share of interest? Ii owned with someone other an spouse, indicate with whom.
c�C-a�-oa-�3-Cr�. E�3--�o3
If name on record is different Ihan lhat of appticani, indicate below: Is lhe property in question:
❑ Real Pioperty p Mobile Home pC 61.
�me of moAgagee or contract seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
of assignee or other owner or holder of mortgage
Address of assignee p � �C� (� �
Dces appliwnt own prc S�uC�� � � �
1� 3 3t Taxing District?
counry in Indiana? �Z�� � ��
COUNTY AUDITOR
Deduction approved in the amount of:
20
Signature
�II���I��m
P � i3
_ County Auditor
Has this dedudion been requested on
propeRy for current year? � Yes � No
zo
�
certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent 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
esiaent atltlre�s of applicant � �Address of authorized person
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