HomeMy WebLinkAboutMortgage_Preske� �
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S«� / State Fortn 43709 (RS / 4-03)
� PresaiDetl Dy Deparlment of Laal Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county wAere the property is located.
Filing Dates: 1J Real Property: During the 12 months 6e%re May 11 o/the year the deduction is [o be eHe�dye.p 9 2006
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yearlhe deduction is fo be eHective.
See reverse side lor additional instnicfions and qualifrcations. ��µ ��
_� 1�-- I 3-�3 -° 3C� ,� 1 3 8,� ,.cc��.�,� 7v A� ITOR
(owner
see res[rictions on ieverse side)
Tauing Distrid // Key number / legal description Record number � �
' U
�i1Y%vW//4WGC� �� 3-b /3 �a-�� Page number �
Assessed value of real property as of Mortgage / Contract indebfedness unpaid as of Is lhe applican the sole legal or equitabte
March 1, curtenl year March 1, currenl year ownef? ❑ Yes ❑ No
V �O
Ii �io, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
It name on record is different than that
of mortgagee or contrad
indicate below:
Address of mortgagee or conlrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Is the property i
❑ Real Propert�
�fh� v vV —
Address of assignee (num6er and sUeet, city, state, ZIP code) q Q�0
Does applipnt own property in any other If ves. what county? � a�
county in Indiana? �,ka�
-- — (\
couNTV au►
approved in the amounf of:
20 �z
Signature
20 ��
P
20 �9 20 20
P
County Auditor
❑ Mobile Home QC 61.
0
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d��. °° �
� �U,� ,�
�,�"'`'� �
C�/ _�n requested on
� �.,�rentyea(?�Yes❑No
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and ihat the applicants was / were
resident of Indiana and owner of the atorementioned property on March 1, 20
�n r(owners ful1l name Person authorized by duly executed Power of Attomey
. _ . � _ � ✓/ � � . . or by IC 6-1.1-12-.07
address of
of authorized person