HomeMy WebLinkAboutMortgage_Jones/�n � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' „ FOR DEDUCTION FROM ASSESSED VALUATION
'' - _ �J State Fam 43709 (R6 / 5-061
�� Prescribed by Dapertmenl of Lopl Grnemment Finance
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INSTRUCTIONS: NOV �F�LUUO
To 6e /iled in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1) Real Properiy: Dunng the 12 months 6e%re �une 11 ot fhe year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year tiY9�e uc� be effective.
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See reverse side lor additional instroctions and qualifications. Q�pN CO NiV AU81fi��
orcantract buyer- � restridions on
�'�' �,
Assessed value of real
March i, curcent year
as of
no, whaf is his / her exacl share of interest?
If name on record is different Ihan lhat
of mortgagee or contrad
Address of mortgagee or conVact seller
Name of assignee or other owner or holder of
Key number / egal description Record number
�G i3- o-a� �/.�/�-�� �od�
�,%`)� , D/� � � Page number n
�.�., y.
Mortgage / Contrad indebtedness unpaid as of is the applicant the sole legal or equitable
March 1, curtent year ownef? ❑ Yes � No
indicate below:
.��r Y . . i i..
and street, city, st
Address of assignee (numberand street, city, sfate, ZIP
Does applipnt own property in any other I If yes, what county?
counry in Indiana?
Deduction approved in fhe amount of:
20 � 20
1
Signature
�
20 O �
�
with someone other than spouse, indicate with whom.
sthe property
❑ Real PropeAy ❑ Mobile Home QC 61.1-n
� " ��' ly , �%�Q�.:.G.7.$�
Dl"il\�'CI' \�1J�
Card ��• .....................
What Taxir _..��uion been requested on
Iproperty for wrrent year? � Yes ❑No
COUNTY AUDITOR
County Auditor
20
20
Date
20
We certify under the penalry of peryury that the above and foregoing infortnation is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature
Full resident address of
t,3o3 � . 25
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person