HomeMy WebLinkAboutMortgage_BettagSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION ,yr�,C�ounp Township Year
�. w� / State Form 43709 (R5l 4-03) p � {; � [�''� y
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� PrescnDed Oy Department of �ocal Govemment Finance
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INSTRUCTIONS: File�Mark
To be filed in person or by mail wdh the County Auditor o/ the counry where the propeRy is located�
Frlin Dates: 1 Real Pro e Dunn the 12 months before Ma 11 0l the `�'"' ��.,f� q
9 ) P rtY� 9 y year the deduction is to 6e ef/echve,� i� TY �UU1TG. �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to 6e e/fective.
See reverse side (or additional instructions and qualifications.
Applicant (ownerorcontract 6uyer- see nctions on reverse side)
Tacing Distrid Key nu / legal description Record number
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�� Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the, �s le legal or equitable
March 1, curtent year March 1, cunent year owner? ❑ Yes ❑ No
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if no, what is his / her exact share of interesl? {f owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is�the �property in question:
LYReaI Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contrad seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher If yes, what wunty? What Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? property for current year?� Yes� No
� / COUNTY AUDITOR
Deduction approved in the amount o
20 �,� 20 O�C 20 � 20 �_ 20 �� 20 20
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Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicants was / were
resident of Indiana and owner of ihe aforementioned property on March 1, 20
Signature (owners /ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fu resi ent address of app iwnt Address of authorized person �
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