HomeMy WebLinkAboutMortgage_Poeii� �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
��` FOR DEDUCTtON FROM ASSESSED VALUATION
� + State Form 43709 (R6 / 5-06) � .
�« Presaibed by DepaRmen� of Loqi Gavemment Finance
INSTRUCTIONS: File MaAc
To 6e filed in person or by mail wilh the CountyAuditor of the county where the p�operty is located. a�
Filing Dates: 1) Real Property:. Dunng the 12 months before dune 11 of the year the deduction is to be eBeQ(W ��
2J Mobile Homes assessed under /C 6-1.1-7: Between January 15 and March 2 o��ifi�ll�dLdfid0lF�Yq 6e effective.
See reverse srde for additional instiucfions and qualifications.
Applicant
Taxing
Assessed value of real property
March 1, current year
If no, what is his / her exact share of interest?
side)
number / legal description
Mortgage / Contrad ii
March 1, current year
on record is difterent than that of applicant, indicate
of mortgagee or contrad seiler
of mortgagee or contracl seller (number and st2et,
assignee or other owner or holder of mortgage
of assignee (number and st2et, city, state, ZIP
Does applipnt own property in any other If yes, what county?
county in Indiana?
approved in lhe amount of:
20 � I 20
Signature
�
as
Record number
number
Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
If owned with someone other than;spouse, indicate wilh whom.
�Y��6. 11� _.. OS•A2y
0
❑ Real Property ❑ Mobile Home pC 6�1.1-�
U1':11YC1' I�`Q.�S•...�—
�
Cal'd !�`O. .... � 1 �p j
i
� S�wI.J �
What Taxing Distrid'!
COUNTY AUDITOR
20 20 20
Couniy Auditor
� :sted on
property for wrtem y�... ._ e'es� No
20
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicanls was / were
esident of Indiana and awner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
address oi appliwnt �Address of authorized person