HomeMy WebLinkAboutMortgage_Conder� i-�� STATEMENT OF MORTGAGE OR CONTRACT INDEoTEDNESS
j`i' ? FOR DEDUCTION FROM ASSESSED VALUATION o t T hi Year
J SUte Fortn 43709 (R6/ SO6)
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� Presaibetl by Deparimenl of Lacal Govemment Finance
INSTRUCTIONS: � Fi��
To be filed in person oi by mail with the County Audito� o/ the county whe�e lhe p�operty is located. a`�
Filing Dates: 1) Real Property: Dunng the 12 months be(ore June 11 of fhe year the deduction is to bg�6�V� UNTY AUJITOR
2) Mo6ile Homes assessed under IC-6-L 7-7: Between January 15 and Maroh 2 of the yea� the deducG'on is to be eSective.
See reverse side for additional instiuctions and quali(ications.
Applicant er or contract buyer- see restrictions on reverse side)
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Tauing Distrid Key number / legal de'scription Record number ��� n
/
' a?lo -/3 - /3 -3ov -OQ'�, /�S Paye number y 9 (o �'
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or
March 1, wrrent year � March 1, cunent year ownef? �' ❑ Yes � No
� I gi�o vvv-
16 no, what is his / her exad
name on record is difterent than lhat of applicant,
If owned with someone other than spouse, indicate with whom.
me of mortgagee or contract seller �%�� � ` �,�,' �
� �C%Q� � .�" ",`. ��'! ' ' '-.` �
Address of mortgagee or contra eller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder ot mortgage
(number and street, city, state, ZIP code)
Is the property in
❑ Real Properiy ❑ Mobile Home (IC 61.1
Q
Dces applicant own property in any other If yes, what counry? What Taxing District? I Has this dedudion been requested on
county in Indiana? o
Drawer NO.°�07�.�•'•�O�_
COUNTY AUDITOR
Dedudion approved in the amounl of: CaCd NQ. :�,L.%.Q: ��
20�_ 20 O 20 20 20 �� ' I[� �
P P
Signature
County Auditor
Date
We certify under the penaity of perjury that the above and foregoing information is true and corred and that the applicants was / were
esiden, of Indiana and owner of tne aforementioned property on March 1, 20
(ull name)
resident address of applicant
1077� � Iz 5 S
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 .
of authorized person