HomeMy WebLinkAboutMortgage_BysarovichSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. w/ State Fwm 43709 (RS / 4-03)
�! Prescribed by Department of Local Govemment Financa
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INSTRUCTIONS: ���ji-�i' ��jd I File Malic ;)
To be filed in person or 6y mail with the Counry Auditor of the county where the propeRy is locate'd g!{.—J .�.--� �'J`�
Filing Dates: 1) Real PropeRy: During the 12 montAs befo2 May 11 01 the year the deduction is to be eHecfive.
2) Mobile Homes assessed under IC 6-1.1-7: Belween January 15 and March 2 of the ye�r�he �duc� to be effective.
See reverse side for additional instructions and qualifications. �' n �
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Applicant (owner orcontract r s rest 'ctions on rse s' �j " �:�-'��: �"�.' •"--
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Taxing Distrid Key number / legal description Record number
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Assessed value of real property as o MoRgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, cunent year March 1, current year owneR ❑ Yes ❑ No
3 Do 0
If no, what is his / her exad share of interest? If owned with someone other fhan spouse, indicate wilh whom.
If name on record is different ihan thaf of applicant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Modle Home QC 61.1-�
� e of mortgagee or contrad seller �
Address ot mortgagee or contract seller (number and s et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand st�eet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? Whal Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 0,� 20 D l 20 O'7 20 _� 20 Q� 20 20
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Signature County Auditor Date
�-�(Je certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners lull name) . Person authorized by duly executed Power of Attomey
�. .. . . / or by IC 6-1.1-12-.07
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Fu r a en �address of applicant Address of authorized person
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