HomeMy WebLinkAboutMortgage_Fromme�
� «•
i
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (RS / 4-03) '
PrescnGetl by Depanment of Local Govemment Finance -
INSTRUCTIONS:
To 6e filed in person or by mail with the CountyAuditor ot the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months be%2 May 11 o(the year the deduction is to b���ctiv� 2��6
2) Mo6ile Homes assessed under IC 6-7.1-7: Between January 15 and Maich 2 0/ the year the deduction is to be e((ective.
See reverse side for additional instructions and quali�cations.
Applicant (owner or
on r� yerse side)
i axing uistna 1/ Key number / legal descriptio Record number
� p/�'G � (
� �/`�� � _Q� Page number � %
v /
Assessed va�ue of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sote legal or equitable
March 1, current year March 1, current ear owner? ❑ Yes ❑ No
�� �
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
I( name on record is different lhan lhat of applicant, indicate below:
�me of mortgagee or contreIX seller I
l,% U
Address of mortgagee or contrad seller (number and st2et, city s.
Name of assignee or other owner or holder of mortgage
ZIP
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District?
county in Indiana?
� --^°� iNn' AUDITOR
Deduction approved in
20� zc
I
Signature
Drawer i\'0...
................
Card NO. .. � �o - / �ja.!7.
County Auanu�
20
s the property in question:
❑ Real Property ❑ Mobile Home (IC 61.
Has this dedudion been requested on
property for current yea(? � Yes ❑ No
zo
Date
�
We certify under the penalty of perjury ihat the above and foregoing information is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
(owners (ull name)
address �j( applicant
\ l � �
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person