HomeMy WebLinkAboutMortgage_McGregorSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
\ � Sffie Form 43709 (R3 / 10-00)
�
� Presaibed Ey State Boartl of Tax Commissioners
Instructionsforfiling:
To be filed in person or by mail with the County Auditor of the county where the property is
located durina the 12 moMhs before Mav 11 of the vear the dedudion is ro be effedive. See
FORM 5
Coun Township Year
i i ' , I,�
i
JUL 18 2001
reverse side for additional insUudions and qualfiptions.
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Appliq ��r ntract buyer- see 2stnctions on 2verse de) '. .. '"""-� , '.
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Taxing DistriG Key number / legal description Record number Q/
�Q h�"� �� � QD3 � Q�i �O 0— O U Page number Y
Assessed value of real property as of Mortgage ! Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, curreM��� � 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:
P� of mortgagee or contrad seller �
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Address of mortgagee or conVad seller (number street, cify, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sGeet, dty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing DisVid? Has this dedudion been requested on
other county in Indiana? properry for wrrent year? � YesD No
COUNTY AUDITOR
Deduction approved in the amount of:
4
20 �� `• 20 .3 20 20 20 � 20 F� % 20 ��
5 .rv P � o
P,����- � P �
Sig ature County Auditor Date
�I e ceRify under the penalty of perjury that the above and faregoing infortnation is We and corted and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20 .
Signa e(owners lull name) � Person authorized by duly executed Power of Attomey
Z$P �� 7 5�� � or by IC 6-1.1-12-.07
Fuil resident address of appti nt Address of authorized person
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