HomeMy WebLinkAboutMortgage_Sams� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
'�. � ♦ Siate Fortn 43709 (R5 / 4-03)
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� PresaiDeA by DepaM1meni of Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
��' � � I , --y ��
AUIi 1 - 20U3
File Mark
To be filed in person or by mail with the County Auditor of the counry wAere the property is located. �� n
Filing Dates: 1) Real Property: During the 12 montbs before May 11 01 the year the deduction is to 6e efrecti .ve �� �� l�
2J Mobile Homes assessed under lC 6-1.1-7: Behveen January 15 and March 2 0/ the year the:deduction �s to be eNective: �
See reverse side for additional instructions and qualifrcations.
Applicant (ownerorcontract buyer- see restric[ions on reverse side)
Tauing Dislrid Key numbe / legal de 'ption Record number
03
Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applican� the sole legal or equitable
March 1, current year March 1, wrrent year ownef? ��'es ❑ No
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If no, what is his / her exact share of inleresl? If owned with someone other fhan spouse, indicate with whom.
If name on record is different ihan thai of applicanl, indicate below: Is the property in question:
Propelty ❑ Moble Home pC Gt.1-�
�ame of mortgagee or contrad seller —
Addres�� ortgagee or contrad seller (number and sf2et, city, state, ZIP //? E 9��J
Drawer NO..�� :1...........
Name of assignee or olher owner or holder of mortgage ..
,�
, Card_-NQ . ......................
Address of assignee (number and st2et, city, state, ZIP code) y
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for curtent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in lhe amounf of:
200 20 �,� 20 � 20 �`L 20 �_ 20 20
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Signature County Auditor Date
�I I We certify under the penalty of perjury thal the above and foregoing information is true and corred and that lhe applicants was / were
a resideni of Indiana and owner of the aforementioned property on March 1, 20
Signature w ers f I name Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F I resident address of applicant Address of authorized person
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