HomeMy WebLinkAboutMortgage_Hurt��n � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
a' � FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�M / Stata Fortn 43709 (R6 / 5-06) � �
Presaibed by Department of Loral Gwemment Finance
iNSrRUCnorvs: MAR 0 �i�gp,�
To be /iled in person or by mail wrth the CountyAuditor of the counfy whe�e the property is locafed. �
Filing Dates: 1J Real Property: Dunng lhe 72 months before June I f of the year the deduction is to be eHgE��.,
2) Mobile Homes assessed under IC 61.1-7: Between January 15 and March 2 0/ the���ONe de�'u��to be elfective.
COUNTY AUDITOR
See �everse side for additional instnictions and qualifications.
Applicant
r- see restr�cnons on
number / legal descriplion � Record number
Page number
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the so�e legal or equitable
March t, wrrent year March 1, current year owneR ❑ Yes ❑ No
4 sa�
I( no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that o( applicant, indicate below: Is the property in question:
mortgagee or conVact seller
Address of mortgagee or contrad selier (number and
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sVeet, city, state, ZIP code)
Dces applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
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P
Signature
❑ Real Property ❑ Mobile Horne QC 57.1-�
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'� �� � 5� � quesled on
� Yes❑ No
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couNnra ���
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County Auditor
C-ahQ � u� � {� w-��-
Date
certify under the penalty of perjury that the above and foregoing information is true and corred and thal lhe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
(ull
a
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person