HomeMy WebLinkAboutMortgage_Mason (17)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
♦ � Siate Form 43709 (R3 / 1400)
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� PreSaibetl �y Stale BoarC ol Tax Cortvnissioners
InsWctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effective. See
reverse side far additional insWdions and qualfications.
fORM 5
Coun Township Year
File Mark
Applicant (owner or contract
des ' tion Record number
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I Page number
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Assessed value of real property as o Mortgage / Contraq indebtedness unpaid as of . Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year � owneR ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below:
A of mortgagee or contrad seller • -.
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Address of mortgagee or conVact sel (number and street, city, state, ZIP ,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sUeet, aty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing DisVid? Has this dedudion been requested on
other county in Indiana? property for current yeaR � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
zo _03 B�e zo �.� zac :, so �,� Zo n C zo �� zo o� P
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Signature County Auditor Date
�I e certify under the penalty of perjury that the above and foregoing infortnation is We and corred and that the applicants was / were
ident of Indiana and owner of ihe aforementioned property on March 1, 20
Signature (ownels /ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
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Full resident d ess of appli nt Address;of author¢ed person
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