HomeMy WebLinkAboutMortgage_Dawson (3)..,,,
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Pofm 43709 (R4 / 10.01) .
Presmbcd by Department ot Local Govemment Finance
Coun Township Year
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To be (led in person or by mail wifh fhe County Auditor o/ the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 of the �i is fo_6e effective! (/.{/�
2) Mobile Homes assessed under IC 6-1.1J: Befween January 15 and March 31 of he year the_tleduC6on�is-�be effective.
W7 Y FUDITOR
See reverse side for additional inst�uctions and quali(rcations. , G1a5��� �vUyT
Applicant (owneiorconfract buyer- see res(ricti on reverse side)
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Taxing Distrid Key number / legal descripti n Record number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owne(1 ❑ Yes ❑ No
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I( no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
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If name on record is difierent ihan that of applicant, indicate below: Is lhe property in question:
❑ Real Propeity ❑ Mobile Home QC 61.1-n
'ame of mortgagee or contrad seller
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Address of mortgagee or contred seller (number and street, city, tate, ZIP
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Name of assignee or other owner or holder of mortgage
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Address of assignee (numberand s6eet, city, state, ZIP code) ,
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Does applipnt own property in any other If yes, what county? What Ta g Distrid? Has lhis dedudion been requested on
county in Indiana? property for curtent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduclion approved in the amounl of:
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Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applipnts was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
' n (o ners 11 name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of applipnt Address of aulhorized person
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