HomeMy WebLinkAboutMortgage_HeironimusSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
` J Spte Form 43709 (R3 / 70-00) .
4r
� PresaibeE by State Board o1 Tax Commissioners
Instructionsforfiling:
To be filed in person or by mail with the County AudRor of the county where the property is
located during the 12 moMhs before May 11 of lhe year the dedudion is to be effedive. See
reverse side for additional insWCtions and qualfiptions.
FORM 5
AUG 3 i 2001
�����
(� �p �(]` + �--� _ I.�CkS .CC7 I. ✓7 q G��� I':i Y FtUD!TGR
Applipn owne cont 6uyer- ee stnctio�s on 2v/er^se Mside) ,
v„ /� .
Taxing DisViG Key number / legal description Record number /�
/
DD %� �O /3 7 9 �Q� Page number /� � ( /
.� �) �y .
Assessed value of real property as of Mortgage / Contracl indebtedness unpaid as of Is the appticant the sole legal or equitable
March 1, current year March 1, surtent year owneR ❑ Yes � No
�(p� /o�
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�e of mortgagee or contrad seller .
Address of mortgagee or conVad seller (number and stieet, city, state, IP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, aty, state, ZIP code)
Does applicant own real property in any If yes, whal county? What Taxing DisUict? Has this dedudian been requested on
other county in Indiana? property for wrrent year? � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amounf of:
20 � 20 20 20 0� 20 /� • 20 n y 20 �_ 9
5 G.�oPr� � %� � P P
Signa re County Auditor Date
�I e certify under the penalty of peryury that the above and foregoing infortnation is true and correc[ and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
� ignature (ow rs /ull name) , , Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
F 1 dent address of appliqnt Address of author¢ed person
/2..Z 13ox Z83 Oa/�/o��/ G=F