HomeMy WebLinkAboutMortgage_Marshall (4)e`"rt�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� � FOR DEDUCTION FROM ASSESSED VALUATION
S / State Fwm 43709 (R4 / 10-07)
�� Prescribed by Department of Local Govemment Finan[e
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the counly where the propeRy is located. e�i � 2 c� 2002
Filing Dates: 1) Real Property: Dunng the 12 months 6e)ore May 11 0/ the year the deducfion is to 6e efjec6ve.
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 0/ t year the d du�dn is to e e ective.
See reverse side /oradditional instructions and quafifications. /������
GI3SON COUi TY AUDITOR
Applicant (owner or contract buye - see rest ' tio e side)
Taxing Dislri Key numb / legal description Record number
�( /�L�� b��_f�/1/ �C�'_O"� Pagenumber
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Assessed value of real property as of Morfgage / Conlrad indebtedness unpaid as of is the applican e sole I gal or equitable
March 1, curcent year March tASUrrent year ownef? ❑ Yes ❑ No
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If no, what is his / her exad snare of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanf, indicate below: Is the properfy in question:
❑ Real Property ❑ Mobile Home QC 61.1-n
��ne of moAgagee or nVad seller �
- J.
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage �
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distric[? Has this dedudion been requested on
wunty in Indiana? property for currenl yeaf?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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G-w- Pr�a� f'�'%�$a# P P
SignaWre County Auditor Date
�� We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that ihe applirants was / were
�lsident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power oT Attomey
,� or by IC 6-1.1-12-.07
F resident address of applicant Address of authorized person
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