HomeMy WebLinkAboutMortgage_Ireland (2)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�. �� I State Fwm 43709 (RS / d-03)
� Prescribed by Department of Loral Govemment Finance
�RUCTIONS: Fiie Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dafes: 1) Real PropeRy: During the 12 months before May 11 af the year fhe deduction is�to be eRecfive '�
2) Mobile Homes assessed under IC 6-7.1J: Between January 15 and March ?'.of the,��year the de{duction� be e8ective.
See reverse side for additional instructions and qualifications.
D E C 12 2003
P.pplicant (o contract 6uyer - s restrictions o� v e') ,, /� �
/] . 'l�W�� '-� ...� . l 1 � �
tC./�./ _-` ,
Taxing istrid Key number legal description ^Record'nurob'er �u�� �O�'
O Q� � n^ ^('S� Page number �.� /
r �� `� ��o
Assessed value of real property as of Mortgage / Conlract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curcent year � owner? ❑ Yes ❑ No
� �- � s� O
If no, what is his / her exact share of interest? If owned with someone other than spouse, indirate with who
- .3 - -.�av - 66a. ,3�9_ G��
If name on record is diHerent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC E1.1-7)
,�" e of moAgagee or contract seller -
�
ress of mortgagee or contract seller (number and street, y, state, P
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Dislrict? Has this deduction been requested on
county in Indiana? property for cunent year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 O 20 20 20 20 � 20 � 20
P�R�� �P � P
Signature . � Counry Auditor Date
I �I�
1 i We certify under the penalry of perjury that the above and foregoing information is true and cortect and that the applicants was I were
�! zsident oi Indiana and owner of the aforementioned property on March t, 20 .
ature (owners (ull name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full r sident address of applicant Address of authorized person
�� �