HomeMy WebLinkAboutMortgage_McClearySTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSED VALUATION
t , State Form 43709 (R3 / 10-00)
ur
� Prescribetl by State BoaN M 7az Commissioners _
Instructionsforfiling:
To be filed in person or by mail with the Counry Audftor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for addifional insVudions and qualificalions.
FORM 5
OCT 2 6 2001
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Applicant (owner or contract y r- see rastrictions on reverse side� _,
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Taxing Distrid Key number / legal description Record number �
� � � � — Page number �
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, curtent year owneR ❑ Yes ❑ No
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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:
N� of moAgagee or contrad seller ,
Address of mortgagee or conVaG seller (number and street, city, state, ZIP .
Name of assignee or other owner or holder of mortgage
Address of assignee (nuinber and st2et, dty, state, ZIP code) '
Does applipnt own real property in any If yes, what wunry? What Taxing DisVid? Has this dedudion been requested on
other county in Indiana? property tor current yeaf? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
,by
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Sign re County Auditor Date �
I! e ceR'ify under the penalty of perjury that Ihe above and foregoing informa6on is We and corred and thal the applicants was / were
ident of Indiana and owner of the aforemenGoned property on March 1, 20
Sig ature (owner's fufl name) Person authorized by duly executed Power of Attomey
r or by IC 61.1-12-.07
ull resident address oi appliqnt Address of author¢ed person
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