HomeMy WebLinkAboutMortgage_Smith (2)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
` FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
: �� / Siate Fwm 43709 (RS / 4-03)
P2svibed by Department of Local Govemment Finance
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INSTRUCTIONS: � � � i4� �ileiMarfc)
To be filed in person or by mail with the Counry Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 of the yea� the deduction is fo 6e eNective.7��1�
2J Mo6ile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 o/the �eartAe dedLction is to be eflective.
See reverse side for additional instructions and qualifications.
buyer-
value of real property as
March t, current year
If no, what is his / her exact share of interest?
reverse
Key number / legal description Record number h/,
!/ � •r
�/ j_ _(�� ]SS'��T Page number �
/ ((J Zi1 oi
MoRgage / Contract indebtedness unpaid as ot Is the applicant the soie legal or equitable
March 1,�nt year owne(? ❑ Yes ❑ No
name on record is different than that of applicant,
oi mortgagee or contraIX seiler
of mortgagee or contrad seller (number and
Name of assignee or other owner or holder of mortgage
of assignee (numberand sf2et, city, state, ZIP
� � �
owned with someone other than spouse, indicate with whom.
below:
3
t, city, state, ZIP
Does applicant own property in any other If yes, what counry? What Taxing Distrid?
county in Indiana?
Deduction approved in the amount of:
20 ��
Signature
20 Q�
COUNTY AUDITOR
20 �� 20 �_ 20
P P
County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Home
Has this deduction been requested on
property for current year?� Yes❑ No
20
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�sident of Indiana a d ow er of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
i��_f �\�I1 / I� Address of authorized person
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