HomeMy WebLinkAboutMortgage_Hughes (2)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
� / Stata Fwm 43709 (RS / d-03)
PresaiEed by Depanment of Lacal Govemment Finance
Coun Township Year
INSTRUCTIONS: � File Ma�
To be filed in person or by mail with t6e CounryAuditor of the county where the property is locate� �� C.r'
Filing Dates: 1) Real Property: During [he 12 months be%re May 11 0/ the year the deduction is tb1be e t��•-J
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea U�e�deductio�i6�o be eBective.
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See reverse side for addifional instructions and qualifications.
_ � � - I 3 - I I, - z � -ac� �l ��-1 �; � 4�_i � /1 D
(owner or contrect
Taxing District
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Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
Key number / legal
603 --bo y��/-dc�
March 1, cyqenl year
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Record number
Page number `�'
r�-i
as of Is lhe applirant the sole legal or equitable
owner? ❑ Yes � No
If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: I� \property in question:
l
� Properry � Mobile Home (IC �1.1-7)
of mortgagee or contrect seller /. ` .,
5.3 �\
Address of mortgagee or contract seller (number and st� et, city, state, 21P (�j� fi• '
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Name of assignee or other owner or holder of mortgage
street, city, state, ZIP code)
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o�. . .a�
Dces applicant own property in any oiher If yes, what county? � Has this deduction been requested on
county in Indiana? �J� property for current year? � Yes❑ No
COUNTY AUDIT(,..
20
Signature
approved in the amount of:
20 �
20 � 20 �'i 20 Q
T p
�
County Auditor
20 I) 1 20
P
Date
certify under the penaity oi perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
lent o( Indiana and owner of the aforementioned property on March 1, 20
's (ull
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resident addre
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ofauthorized person