HomeMy WebLinkAboutMortgage_Helmbrecht�a ! STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
'i��; FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownshi Year
�� J Sta�e Fortn 43709 (R6/ 5-06) "�(
� Presaibed by Department of Local Gwemment Finance �
INSTRUCTIONS: OCT 1F�e 14ia�rk
To be trled in person or by mail wrth the County Auditor o/ the county where the property is located. �
Filing Dates: f) Real Property: Dunng the 12 months 6efo2 ,lune �l of the year lhe deduction is to be elfe�
2J Mobile Homes assessed unde� IC 6-7.1-7: Between January 15 and Ma�ch 2 0l the year the ded s�g@Hective.
G�gSON C
See reverse side fo� additional instructions and qualifications.
Taxing
(oy�ner or conhact
C�
C.7c0— / 7—/d —o'�
Assessed value ofrealproperty as of �,
March 1, aurent year ^�t^``''
r•
what is his / her exad share of interest?
If name on
Key number / legal description I Record number�
� V
• �OO I � —�v Page number �� 3
MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year owneR ❑ Yes ❑ No
. � �U
If owned with someone other than spouse, indicate with whom.
thaf of applicant, indicate below:
moAgagee ar contrad seller
Address of mortgagee or conVad seller (number and street, city, state, ZIP
Name of asaignee or other owner or holder of mortgage
Address o( assignee (number and street, city, state, ZIP code)
Does applfcaM own property in any other If yes, what counry7
county in Indiana9
Deduction
20 V a
P
Signature
in the amount ot:
20 �_ 20
P
What Taxin
COUNTY AUDITOR
�
County Audilor
❑ Real
�
� Mobile Home QC 61.1-�
Dra�r�er NO.�.�i:-..2.9 9.3
Card NO. ......:.. �....
20 20 _
Date
20
on
No
�' We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
esidenl of Indiana and owner of the aforemenlioned property on March 1, 20
� i ature (owne/ full na e) Person authorized by duly executed Power oi Attomey
� � or by IC 6-1.1-12-.07
, ull r sident address of applicant �� ,.� , Address of authorized person
n