HomeMy WebLinkAboutMortgage_Burkharte`°N°° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`s "° .: FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
S�J State Fofm 43709 (R4 / 70-01)
i �a.
.� Prescribed by Departmenl of Local Govemment Finance —� ��� � i�
� 1; 1's� _ _J 1.�
INSTRUCTIONS: File,Mark
To be filed in person or 6y mail wifh the County Auditor o/ the county whe2 the propeRy is located. F t� 1- ��U�
Filing Dates: 1) Real Property: Dunng the 12 months be(ore May 11 o/the year the deduction is-to be eflective. �� n
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 �the year the deduction is�to be eNective.
See reverse side foradditional instructions and quali�cations. Ct_S� �1 C��' T'1 F.UDi'CR
Applicant (own or contracf 6uyer - see restnctions on verse side)
- � `Pc.��.� ,
Taxing Distrid Key number / legal description Record numbe
- 3
_ _ _'\ Page number
'-CJ
Assessed value of real property as of MoAgage / Contracl indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, current year owner? ❑ Yes ❑ No
��
If no, what is his / her exacl share of interest? If owned wifh someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
�me of moAgagee or contrad seller `
Address of mortgagee or contrad sefier (number and street, crty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year?� YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
zo 4',� 5 zo � zo a,r zo �� zo t3 -7 zo o� zo 0
� � 10 �,�� �,p.P�° ,Q p �, � �
r �
Signatur County Auditor Date
I� We certify under the penalty of perjury lhal lhe above and foregoing informalion is true and correct and that the applicants was / were
�aident of Indiana and owner of the aforementioned property on March 1, 20
ature (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F I residen[ address of applicant Address of authorized person