HomeMy WebLinkAboutMortgage_Laidlawi�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS '
`�FOR DEDUCTION FROM ASSESSED VALUATION Coun hip Year
' State Fortn 43703 (R6 / 5-06)
� Presaibed by Deparimem of Laal Gwemmen� Finance }�
FE
INSTRUCTIONS: � � 5]IE Mark
To be filed in person or by mail with the County Auditor ol the county whe�e fhe property is located. ��'�4� ��(�
Filing Dates: 1) Real Property: DuAng the 12 months be%re �une 11 0( the yea� the deduction is to be elfecti4�TY AUD�T�R
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the yea� the deducGon is to be efiective.
See reverse side /or additional instiuctions and qualificaG'ons.
Applicant (o er r contract 6uyer- se ' ons o rse side)
Tauing District Key number / legal description Record number
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a %�a -�.3 -/Oo '� i • � a a -C�oy Page number � � oS
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant th ole legal or equitable
March 1, current year March 1, current year owne(? �s ❑ No
a s ood '
If no, what is his / her exact share of interesl? If owned wilh someone other than spouse, indicate with whom.
If name on record is difterent than that o( applicant, indicate below: Is th propeRy in question:
eal Property ❑ Mobile Home (IC E1.1-�
' e of moRgagee or contrad se/lle/r%
Gl/ � �L
Address of mortgagee or conVad seller (number and street, city, st , ZIP
Name of assignee or other owner or holder of mortgage _
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Address of assignee (number and st2et, aty, state, ZIP code) � 1
,_ o� , ?S��!�.
Dces applicant own property in any olher If yes, what counry? What Taxin; t• \O •�� •� � t m
county in Indiana? �11�� � , 1'Vo
C1l �
\�. ........... ' �
COUNTY AUDITOR
Deduction approved in the amount of:
20�_ 20�_ 2 20 20 20 20
P I° 1 � �
Signature County Auditor Date
� We certiy under the penalty of perjury that the above and foregoing information is lrue and corred and lhat the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Signature ers lull nam Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
resident a ess af applicart Address of authorized person
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