HomeMy WebLinkAboutMortgage_Block"� rt�"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�" ,� FOR DEDUCTION FROM ASSESSED VALUATION t T i Year
S�y S�ale Form 43709 (R4! 70-01)
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� Prescribcd by DeDartment of Loral Govemment Finance
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INSTRUCTIONS: ile "ark
To be filed in person or by mail with the County Auditor o/ the county where the property is located_
Filing Dates: 1) Real PropeRy: During the 12 months belore May 11 o(the yearthe deduction is to � �N r�1� N?Y 5U ITOR
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ he y he de7iucl�on �s Po 6e effective.
See reverse side lor additional instnictions and qualifications.
on reverse side)
i axmg u�stna Key.number / legal description - Record numberO /
�� � _�/// � Page number� /
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Assessed value of real property as f Mortgage / Conlract indebtedness unpaid as of is the applicant the sole legal or equitable
March 1, cunent year March 1, wrrent year ownefl ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other an spouse, indicate with whom.
- 07 - - � - oo/ /G9- �
If name on record is different than ihat of applicant, indicate below: Is the property in question:
of mortgagee or contract
Address of mortgagee or contract seller
�/ �
um er and st2et, city, state, ZIP
assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, state, ZIP code)
Does applicant own property in any other I If yes, what counry? What Taxing District?
county in Indiana?
approved in the amount of:
20 (��. I � � �I 20
COUNTY AUDITOR
20 O 20 20
�(3oR' �
County Auditor
❑ Real Property ❑ Mobile Home pC 6�1.1
Has this dedudion been requested on
property for wrrent year? � Yes � No
�
Date
20
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certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
(o�yners
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Person authorized by duty executed Power oi Attomey
or by IC 6-1.1-12-.07
of applicant /� r � � IAddress of aulhorized person