HomeMy WebLinkAboutMortgage_Miller (26)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
State Fortn 43709 (RS / 4-03)
P`asaiDeE by Department of Laal Govemment Financa
�lHUCnoNS: File Mark
To be filed in person or by mail with the CountyAuditor of the county wheie the property is Ixated. � �'� ?r�
Filing Dates: 1) Real Property: During the 12 montbs before May 11 of the year the deduction is to 6e ctive� � �--1 � �
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea !he deduGion'is�tabe effective.
See 2verse side for additional instructions and qualificafions. � � T 3 1 20�3
Applicant (owner or contract
Taxing District
� t �
Assessed value of re
March 7, wrtent yea
see restrictions on revers si
Key number / legal descr
� /� ^��
as of Mortgage / Contract
March 1, current yee
If no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicate below:
Name of mortgagee or contract seller
of mortgagee or contred seller
Name of assignee or other owner or holder of mortgage
Record number
(�i Page number ry/}�
\/ �.� ..7
3id as of Is the applicant the sole legal or
owner? ❑ Yes ❑ No
SO V\J
If owned with someone other than spouse, indicate with whom.
city, state,
Address of assignee (number and street, ciry, state, ZIP code)
; the property in question:
❑ Real Property ❑ Mobile Home (IC E1.
Does applicant own property in any other I If yes, what county? I What Taxing District? Has this deduction been requesied on
counry in Indiana? property for current year? ❑ Yes � No
Deduction approved in the amount
20 20 �,�
��8�9-
Signature
COUNTY AUDITOR
20 Q( 20 � 20 _Q� 20 � 9 20
P P
Counly Auditor Date
I I We certify under the penaity of perjury [hat the above and foregoing infortnation is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
executed Power of Attomey
or by IC 6-1.1-12-.07
Rddress ofauthonzed person