HomeMy WebLinkAboutMortgage_Vinnedge (3)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
-' .' FOR DEDUCTION FROM ASSESSED VALUATION � Coun[� �-, ownship Year
�. u.� � $�ate Fo(m 43709 (R4 / 16-01) �
� Prescnbed by Depanment of Local Govemment Finante -
JAN
INSTRUCTIONS: File ark
To be filed in person or by mail with the County Auditor o/ the county where the prope� locat d.
Filing Dates: 1) Real Property: Ounng the 12 monfbs 6e/ore May f 1 o/the year the de�etion-i4'te; � e � �ieti�7�R.
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and ILlarcff�33��ea� the deductwn is to be eHective.
See ieverse side /or additional instructions and qualificafions. , _ _
01 u� ' i`1 - i`1 - I o`-i "
contract buyer_ see restrictio�s on reverse� side) ,
Taxing Distrid / I Key number / legal description <J Record number Q�
� V
QQ� _ � yag� Page number �
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, currenl year owneR ❑ Yes ❑ No
�O! V �/v
If no, what is his / her exad share of interesl? If awned with someone other than spouse, indicate with whom.
on record is different than ihat
�me of mortgagee or contract seller �� �
Address of mortgagee or contract seller (number and street, city,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Dces applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
�If��/lis�Q�1
a R-
ZIP
What Taxing Distrid?
COUNTY AUDITOR
20
County Auditar
20 �
�
� o' - 3
Is t "propeRy i question:
❑ Real Property ❑ Mobile Home QC 61.1-�
Has this deduction been requested on
property for current yeaR� Yes❑ No
20 �_ 20 0
P P
Date
certify under the penalty of perjury lhal lhe above and foregoing infortnation is true and corced and that lhe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
�fe (owners full name) , Person authorized by duty executed Power of Attomey
�n. /. �_ a � y 1. i_ o� ey ic s-�.�-iz-.o�
lress of applicant 0 Address of authorized person
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