HomeMy WebLinkAboutMortgage_Lecocq�
� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
-� M� J � State Form 43709 (RS / 4-03)
PrescnDetl by Department of Local Govemmen� Finance
Coun Township Year
INSTRUCTIONS: ile ark
To 6e fifed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 7) Real Property: During the 12 months before May 11 01 the year the deduction is to be efle
2) Mobile Homes assessed under IC 6-7.1-7: Between January 75 and March 2 of tAe year th��eduction � 5�ctive.
See reverse side lor additronal instructions and qualifications. N`� 'l 2�05
� �n-- �� � I-I - a�C� �j 6C90 � I� �('Y'SL-, �
Applicant (owneror
oistria
restrictions on
� � Key number / legal
Record number
O O � , O ,1 / �^ � — o � Page number ���
�� w a•
Assessed vatue oi real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant lhe sole legal or equitable
March t, wrrent year March 1, curt.ant year� � owner? ❑ Yes ❑ No
�� �
C.J�
If no, what is his / her exact share of interest?
If name on record is different t6an lhat
oi morigagee or contraU seller
indicate below:
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contract seller (number and street, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe�and 5t2et, city, state, ZIP code)
�
Does applicant own property in any other If yes, what counry? What Taxing Distrid?
county in Indiana?
Deduction approved in the amount of:
20 �z
Signature
20
COUNTY AUDITOR
20 � 20 20
P
County Auditor
Is the property
r^ . . �.-.n �
iT�.�-
Has this deduction been requested on
propeAy for current year?� Yes� No
20
Date
20
We certiy undec the penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
resident o( Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
.
�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person