HomeMy WebLinkAboutMortgage_McEllhiney (9).,.,.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FQR DEDUCTION FROM ASSESSED VALUATION
S J Stale Fortn 43709 (R5 / d-03)
i«•
Presrnhed 6y Department of Local Govemmeni Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county where the propeRy is located.
Filing Dates: i) Real Property: During the 12 months be(ore May 11 0/ the year the deduction is to b�e�iv�. 9005
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the ded ction is to be eBective.
See reverse side for additional instructions and qualifications. �-y„ �,�
Applicant
Taxing
contract buyer -
Assessed value of real propeAy as of
March 1, current year
If no, what is his / her exact share�of interest?
If
number / legal
���-���'� �O
Mortgage / ContraG indebtedness unpaid as of
March 1, current year
on.record is different than that of appiicant, indicate below:
of mortgagee or contraU seller �� n�
Record number �
Page number � � �
Is the applicaM the sole legal or
owner? ❑ Yes ❑ No
IIlC�
It owned with someone other than spou,se indicate with whom.
�'G-/3 /9-/�� -�i. 3dj' ��
Address of mortgagee or contraa seller (number ary�"lreet, city, state, ZIP
Is the property
❑ Real Property ❑ Mo6ile Home (IC Fr1.
Name of assignee or other owner or holder of mortgage � �` S✓
_� �r` N z,,�y
�,c €�-� �
Address of assignee (number and sUeet, city, state, ZIP code) D. �
Does applicant own property in any other If yes, what counry? What l ��~ � _., �een requested on
county in Indiana? ,,,,,Nerty for wrrent year? � Yes� No
COUNTY AUDITOR
Deduction approved in the amounf of:
20
Signature
�
��
20 �� 20
P � ��
County Auditor
20
20
Date
20
We certify under ihe penalty of peryury that the above and foregoing intormation is true and corred and that the applicants was / were
resident of Indiana and owner of the atorementioned property on March t, 20
�� ature wners full name) Person authorized by duly executed Power of Attorney
___ _/l i1/_ y�/I/ o� by ic s-i.i-iz-.o�
Full
Frnn��s<u �� y?6vG
of aulhorizzd person