HomeMy WebLinkAboutMortgage_Moore (3)rt�° STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' = FOR DEDUCTION FROM ASSESSED VALUATION
S y State Fortn 43709 (R4 / 70-01)
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� PreSCribeC by Department ot Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
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To be filed in person or by mail with the County Auditor o/ the county whe2 the property is located. E B 5
Filing Dafes: 1) Real Property: During the 12 months be%re May 11 of the year the deduction is to�be ef(ective. ��
2) Mo6ile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 of � year fhe deduc��tlon� is t/o'be ef/ective.
See reverse side /or additional instructions and aualifications. '�,.'����`�"�?-�
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Applicant (owner o c ntract uyer- see resfrictions on reve se side) '^^
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Taxing Dislrid Key number / legal description Record number ^
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3- p/ 3 y�S^Q� Page number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitabie
March 1, current year March 1, currenl year owneR ❑ Yes � No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appticant, indicate below: Is lhe property in question:
�❑ Real Property ❑ Mo6ile Home (IC 6�1.1-�
�ame of mortgagee or contract seller
Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand sheet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District? Has this dedudion been requested on
counfy in Indiana? property for current yeaf? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Audilor Date
I/ We rtify under the penalty of perjury lhat the above and foregoing information is true and correcl and that the applicants was / were
� re ' ent of Indiana and owner of the aforementioned property on March 1, 20
' i r(ow ers full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
u ident a dress of ap li nt � Address of authorized person
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