HomeMy WebLinkAboutMortgage_Guyrt'" STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' • FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
/ SUte Form 43709 (R4 / 10.01)
�a.
� Prescribed by Depannrent W Local Govemment Finance .
INSTRUCTIONS: � � ^' ile M,, rk � �
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months be/o2 May 11 of the year the deduction is to be effecti��R �' ���
2) Mobile Homes assessed under IC 61.1-7: Between January 15 and March 31 0/ the yea� the ded ah e eHective.
See reverse side for additional instnictions and qualifica6ons. � /�� n n
(owner or contr�cj�fiuyer - see
side)
Taxing Distrid ' Key number! legal description
�o��� ��.�n� ��d-000�� �
Assessed value of real prop�rty as of Mortgage / Gontrad indebtedness unpaid as
March 1, current year March�rtent year
jD7�0a
If no, what is his / her exact share of interest? If owned with someone
G/�3 /9�
If name on record is different than that of applicant, indicate betow:
of mortgagee or contrad seller
o( moRgagee ar conVad seller (number and street, dty, state,
Name of assignee or other owner or holder of mortgage
�
Address of assignee (number and sbeet, city, state, ZIP code)
Does appliqnt own property in any other If yes, what wunty?
county in Indiana?
Deduction approved in the amount of:
20
�
I� • .
Signature
�
number
Page number � � /�
f Is the applicant the sole legal or ec
owner? ❑ Yes ❑ No
rthepthan spouse, indicate with whom.
� -b��. G'� OQ�'
�
-y3
❑ Mobile Home (IC 61.
What Taxing District? Has this dedudion been requested on
property for current yeaR � Yes � No
COUNTY AUDITOR
� 20 � i�
�
County Auditor
20
20
� I 20 � �
�
I/ We certify �under the penalty of perjury that the above and foregoing information is true and corced and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
ipnature (owners tiRtic�>'�� Person authonzed by duty executed Power of Attomey
� 4T e/ or by IC 6-1.1-12-.07
,e�
�u1Lrgsident address of applicant " Address of authorized person