HomeMy WebLinkAboutMortgage_MiskellSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� w� / State Form 43709 (RS / a-03) �
� PiesuiDed by Department of Local Govemment Finance �— --
INSTRUCTIONS: OCT (��� ��3
To be fifed in person or by mail with the County Auditor of lhe county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be elfective. (�.�J�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the ar the t1 t o{s-js,,to b�ive.
See reverse side for additional instructions and qual�cations. GIBSON CJOUF�T : AUDITOR
Appticant (owner or contiact buyer- see restrictions on reverse side)
Taxing Distrid Key number / legal description Record number
O 3 _
Page number
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Assessed value of real properry as of Mortgage / ContraG indebtedness unpaid as of Is the applicant t e sole legal or equitable
March 1, wrtent year March 1, wrrent year owneR s 0 No
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If 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 of applicant, indicate betow: Is the property in question:
eal Property ❑ Mobile Home QC 67.1-�
�me of mortgagee or contract seller
Address of mortgagee or contrad selier (number and street, city, state, ZIP /
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Name of assignee or other owner or holder of moRgage
Address of assignee (numberand street, city, sfate, ZIP code)
Does applicant own property in any olher "--- `-' -- —' -- � '/,, o �n requested on
counfy in Indiana? ���� (��-!`�"� �af?� Yes❑ No
Name� ��a�
Document # aoo3 —
Date i 0 - /� - 03
Deduction approved in the amount of: Bank (�`'`��" ��
zo � 20 �_ zo zo _� Zo �� Zo � zo
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Signature County Auditor Date
I
�' We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur owners 11 name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
F I resident address of applicant L.�� . Address of authorized person
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