HomeMy WebLinkAboutMortgage_Beadles� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�. / State Form 43709 (R5 / 4-03) 1�'f '
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� P25CnCed by Department of Lotal Govemment Finance � t• �^ J L�' ,
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INSTRUCTIONS: �+U� UF���
To be filed in person or by mail with the County Auditor of t6e county wbere fhe properry is located.� ��
Filing Dates: i) Real Property: During the 12 months be%re May 11 0! the year the deduction is to-6e eflective./ /�
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of tb`ey�ar the�deduc8 n,is t J6 el(ective.
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See reverse side for additional instructions and quali�cations.
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Appticanl (ow eror c fract uyer - see restn tions on reverse si
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Taxing Di ri Key number / legal description Record number ��
/, , �,. , � � � _ /(� I /� � �a Page number �
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrenl year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? f owned with someone other lhan spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real PropeAy O Mobile Horr�e pC 61.7-�
�3me of mortgagee or contract seller
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP __--- -
Name of assignee or other owner or holder of mortgage , O c1 :.,.) o�0
. Drawer 1�0...... .
Address of assignee (num6er and street, ciry, state, ZIP code)
.. Card NO . .....................
Does applipnt own property in any other If yes, what county? What l .ed on
county in Indiana? y�uperty tor current year? ❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �� 20 20 � 20 �J� 20 �8 20 �� 20
P P
Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
Si natu e(owne/s (ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full es ent address of applicant Address of authorized person
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