HomeMy WebLinkAboutMortgage_BradfieldSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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S / Slate Form 43709 (R4 / 10-01)
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� Prescribed by Depanment W Laal Govemment Finance
MAY 0 g 2003
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Audifor o/ the county whe2 the property is located. �� � ///�
Filing Dates: 1) Real Property: Dunng the 12 months be(ore May 11 0/ the year the deduction is to 6e e�ectwe.,`�.���^,`�7-�--�'
2) Mo6ile Homes assessed under IC 61J-7: Behveen January 15 and March 31 o/the�year�/iE;deduction�is to�be�ef(ective.
See reverse side lor additional instructions and qualifica6ons.
Applicant (ow or contract buyer - see restriction n reverse side) e
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Taxing Distrid Key numb legal description Recor umber
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Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the appliqnpth� sole legal or equitable
March 1, curtent year March 1, curtent year � owneR (�y��es ❑ No
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If no, what is his / her exacl share of interest? If owned wifh someone other than spouse, indi te with whom.
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If name on record is difterent than that of applicant, indicate below: Is the property in question:
eal Property ❑ Mobile Hortie QC 61.1-�
''ame of mortgagee or contract seller
ddress o/ rtgagee ar contrad seller (number and street, ' state, Z
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Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Tauing Distrid? Has this deduction been requested on
county in Indiana? property for curtent yeai'? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor � Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
resident of Indiana and owner of the aforementioned propeRy on March 1, 20
Signa re (owners lull name) � Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull si address of a plicant Address of authorized person
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