HomeMy WebLinkAboutMortgage_FredericksonSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
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` ! State Form 43709 (R5/4-03) . , ' .' . . . .• • . �� � [� T��
� PresaiDed �y Department of Local Govemment Finance f� �
INSTRUCTIONS: � JuL Fi12Ma004 '
To be filed in person or by mail with the County Auditor_of the county where the property is located.
Filing Dates: 1) Real Property:�Dunng the 12 months before May 11 0l the year the deduction is to be e(I�e.� � y�
2J Mobile Homes assessed under IC 6-1.1 J: 8etween January 15 and March 2 0/ the�yea,r,,the�deductlon �s to�be� eHective.
See reverse side for addiUonal instnictions and qual�cations.
Applicant (own�{orcontracf
Taxing District
�C.�l���f
Assessed vatue ofrealproperty as
March t, current year
.
If no, what is his / her exact share of interesl?
name on record is different than that of
of moRgagee or contrad seller
Address of moAgagee or contracl seller
on
Key number / legal description � Record number
O// _ ��- (J(� Page number � /' /' /
v' `7T/ (o
MoAgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or
March t, current ye2r owneR 0 Yes ❑ No
�/, ��
If owned with someone other lhan spouse, indicate with whom.
below:
sfreet, ciry, state, ZIP
assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state,
Dces applicant own property in any other I f
county in Indiana?
20
Signature
approved in the amount of:
20 /riT
code)
DrawerNO ...................
Card NO. ..�J �%' ����
20 _� 20 �_ 20
P P
County Auditor
Is the pi
❑ Real
❑ Mobile Home QC Cr1.1-�
��
0'1-79 33
Has this deduclion been requested on
property for current year? � Yes� No
20
20
We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and thal the applicants was / were
resident of Indiana and owner of the aforementioned propeRy on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person