HomeMy WebLinkAboutMortgage_Pond�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�� � / State Form 43709 (R5 / 4-03)
PtesaiUed by Depatlment of Local Govemment Finance
INSTRUCTIONS: �{ a�
To be filed in person or by mail with the County Auditor of the county whe2 the property is located. � �� Z t L""�
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be eflective. � n
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0 �he year �the�,f�ieduction is to be effective.
See reverse side for additional instructions and quali�cations. �.�SQN J,� �UN qUDl70R
Applicant (ow or confract bu �- �seJe restri tio s on reverse side)
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Taxing ' trict Key number / legal descri tion Record number O�_��
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1 current year owner? ❑ es 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 below: Is lhe property in question:
C�eal Property ❑ Mobile Home (IC E1.1-7)
�e of mortgagee or contract seller �
Address of mortgagee or contract seller (number and street, city, s[ate, ZIP
Name of assignee or other owner or holder of mortgage '
Address of assignee (number and street, ciry, state, ZIP code)
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Does applicant own property in any other If yes, what counryl What Taxing District� . squested on
counry in Indiana? j rj� . .... ... ...... ... � YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature Counly Audiror Date
'' We certify under the penalty of perjury that the above and foregoing infortnation is true and corzect and that the applicants was / were
sident of Indiana and owner of the aforementioned property on March t, 20
Signature o e s(ull r�aqie) Person authorized by duly executed Power of Attomey
� �� or by IC 6-1.1-12-.07
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Full resident address of applicant Address of authorized person
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