HomeMy WebLinkAboutMortgage_Reed (3)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
- �+ / State Fortn 43709 (RS / 4-03)
� I PrescnDed by Department of Loral Govemment Finance
To be filed in person or by mail with the CountyAuditor ol the county where the property is locate� ��Filn Mar�
INSTRUCTIONS:
Filing Dafes: 1) Real Property: During the 12 months be%2 May 11 0/ the year the deduction is to be eflective. 'n
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year tf�ded�c�rt-1sQo be effective.
See reverse side for additional instiuctions and quali�cations.
'�/a�., ,Q�a
Applicanl( v e�orcontractbuyer-s
Taxing Dis rid
�
Assessed value eal property as of
MarcFi 1, current year
no, what is his / her exac[ snare of
If name on
on �yerse side)
�r / legal descriptio Record number
/9-m/0�/-00o..��S- 00%
� /•ry /�� �� � Page number
C/V
Mortgage / Contrad indebtedness unpaid as of
March 1, current year
lhan that of applicanl, indicate below:
moAgagee or contred seller
Address ot mortgagee or conlract seller (number and st2et,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand sfreet, city, state, ZIP
owneft
0
t the sole legal or equitable
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
ZIP
Is the
❑ Real Properiy ❑ Mobile Home pC 61.1-�
Does appliwnt own property in any other I If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaR � Yes 0 No
Deduction approved in the amount of:
20
Signature
COUNTY AUDITOR
20 �� I 20 � 20 20
P P
County Auditor
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
3nature ners full name) Person authorized by duly executed Power of Attorney
� � � � �% _ � or by IC 6-1.1-12-.07
applicanl
�a
Address of authorized person