HomeMy WebLinkAboutMortgage_Dodd (2)��,
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STATEMENT OFMORTGAGE ORCONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 43709 (RS / 4-03)
PrescriDed by Departmem a1 Loral Govemment Finarim
Coun Township Year
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INSTRUCTIONS: N O V �. � ���a�
To be �led in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 72 months belore May 11 0/ the year the deduction is to be effective.0 n n
2) Mobile Homes assessed under IC 6-1J-7: Between January 15 and March 2 otfhe yearihe ded"uction,is�to 6e eBective.
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See reverse side Ior addifional instructions and qualifications. G�/� ggpry COU�!1 ti' RUD�70P. i
Applicant (owner or contrec yer - see restrictions on rev e side)
Taxing District Key number / legal d 'ption Record number Q
OIr„ �Q�(�%���,/� Pagenumber � �O
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Assessed value of property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wrrent year owner? ❑ Yes ❑ 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.
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If name on record is different than that of appiicant, indicate below: Is the property in question:
❑ Real Properry ❑ Mobile Home (IC E1.1-7)
�me of mortgagee or contract seller �
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Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address ot assignee (number and street, ciry, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District? Has this deduction been requested on
counry in Indiana? property for curcent year? ❑ YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 ��v" 20 �,� 20 � 20 O' 20 Q� 20 20
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Si nature County Auditor Date
1 I We certity under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was I were
-esident of Indiana and owner of the aforementioned property on March 1, 20
.gnature (owners.full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
resident address o applica , Addre of authorized person
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