HomeMy WebLinkAboutMortgage_Ewin��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION
' � .J Stace Form 43709 (R6 / SA6)
Presaibed by Department of Local Govemment Finance �
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INSTRUCTIONS:
To be filed in person or by mail with the Counfy Audito� o( the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months befae ,lune 11 of the yea� the deduction is to be eRective.�i 3 2��6
2) Mo6ile Homes assessed under IC 6-1.7-7: Between January 15 and March 2 o/the year the deduc6on is to be effective.
See reverse side for additional instn�c6ons and qualifrcations. �ja`� ���
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_ � _ , GI6jC:Y COUtdTY AUDI70R
see restriction�Qh reverse side)
Tauing Disirid
Assessed value of real property as of
March i, current year
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Key number / legal description Record number O/
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�/�7���� Pagenumber '�nr�J
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Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenl year ownef? ❑ Yes ❑ No
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I( no, what is his / her exacl share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different ihan ihat of applicant, indicate below: Is the property in question:
❑ Real Prop�Ay ❑ Mobile Home (IC 61.
�me of mortgagee or contrad seller 1"'c }S � o��
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Address of mortgagee or contract seller (number and street, city, state, Z!P
or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other I If yes, what^wunty_?� _
county in Indiana?
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Signature
approved in the amount of:
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Dra���er NOo?.o g,�° : .`�.y.Y.�
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Card NO . .....................
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County Auditor
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Has this dedudion been requested on
property for current yeaf?� Yes❑ No
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We certify under the penalty of perjury thal lhe above and foregoing information is true and corred and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
)�n[a�t�u owners ful name/)�/�'' 1 * Person authorized by duly executed Power of Attomey
I" n.. , V1/ W or by IC 6-1.1-12-.07
address of applicairi �Address of authorized person