HomeMy WebLinkAboutMortgage_Deputy"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
__ : FOR DEDUCTION FROM ASSESSED VALUATION
n State Fwm 43709 (R71 / 609) .
S � PresoibeC by �¢p2rtm¢M ol Lacal Govemmenl Fnance
�'NSTRUCTIONS:
To be fi/ed in person or 6y mail with the CounlyAUditor or Counry RemNer of the counry wheie the property is located.
Fdirg Dates: i) Real Properry: Must fi/e duriig the year tor which !he deduction is sought.
2) Mo6ile / ManuFactured Homes not essessed as Real Pmperty.� Musf file dunng the twelve (12J monfhs
6efore Ma2h 37 of each yearthe deduclion is�sotrc�ht.� . .' ��'
See reverse side 7or additional insfrucfions arrd qualificatpns.
Appfr��(awner ar . d b r- see resvi�vns m 2verse sitle) I n. J.� • '
l!
�f _ _. �� � i�0��7� • �
�A1o►Muditor
1 CllfL
County Remtder
. • _ . -°_ ________.. — .._�._._....._.
- 3• - oa • 000`•oa a-.�oo� II 4 sa
Asessed vahre d rr� poperty as W Mongage 1 Contraa in0ebteErress unpaitl az W Abngage / Contra`Y intlebtetlnrss unpai0 as of Is Me ePd��t the sole
MeRh i. m2nt year MarrJ� 1. w``� t�'�yr Gate of appECation kgal w eQUira6le awneR
Il�l��•y ❑Yes ❑No
11 ro, what Is Iris / Mr erar� share of interesi? If owned wiM someor�e dher ihan spouse. iMinte wtlh wfwm
It name m r¢cpy's tlifterent Nan that o( a0P��4 mdidte beb�r. Is the m uestion: Mn
M�PenY� V uaDYAssesstd
❑ Rea� aroaertv ❑ aJmualry assessed
Mc�le Home QC 61.7-i
Name o( rrotgagce u mnttarl se�er
H�-�u
Pild25s o( rtnrt9agee w contraU se4er (numbel and streef, crty, sfate, aM ZIP code)
Name of assiq�ee w otlrer owner w hdder W mongage
AAtlress ot assignee (number aiM stree4 tlry, sfate, aM ZIP cade)
Does epplimnt wm property in any oUier � It yes, what munry? Wtut TaA(g Dislrirl? Has Nis
munry in IMana? • tor arte
❑ Yes ❑ No
' COUNTYAUDROR
Deduction apprwed'm tlie amount at ��
20 20 20 20 20
Sy�aWa W CounNAUd'aw Counry
r�
D2�e (repnth. daY Y'��
20
P�Y
I/ We certify u�er ihe penalry of perjury Nat Ne aDOVe and (wegoing infortnalion is true and correa and Nat the appli�ant is a resident o( Indiana arM
owner I mntraU buyer of ihe afaemenlioned property on date ap0�ication is filed.
� nre (owne/s /u11 �am¢) Date (nwNh, day, yea�
�a.� A._ �Q-�-�° �'�..., i 9, a oiz,
�7 mstlen[ atldrvss of applinnt (num6ar�,+tl str�G tity. stafe. antl ZIP cotle) . _.. ..
or Oy IC fr1.
AGdress of ainha'sed person (number aM s'�ce; dry, state. and ZIP code)
(monfh, daY Y��