HomeMy WebLinkAboutMortgage_Williams (6)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
� � State Form 43709 (R3 / 10-00) -
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,_� Presainea �r state eoam m Tax com�ssiorers
Instructions for fiiing:
To be filed in person or by mail with the Counry Auditor of the county where the property is
located during the 12 moMhs before May 11 of the year the dedudion, is to be effective. See
reverse side for addiGOnal insWdions and qual'fications.
_ � � „_ l �i _ )_ � - hl n �a .��. I n.� I
Appliprrt (¢v�ne� or
Assessed value af real property as of
March 1, current year
no, what is his / her exad
Key number
�b�3 - o �o3�_oa
March 1, currentye
�( lD
as
FORM 5
OCT 12 2001
Record number
number
Is the applipnt the sole legal or equitable
owne(? ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contrad seller
Address of mortgagee or conVad seller (number and street; city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sGeet, aty, state, ZIP code)
Does applipnt own real property in any I If yes, what county? I What Taxing Distrid?
other county in Indiana?
20
amount
20 O , I 20
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COUNTY AUDITOR
�
County Auditor
20
Has this dedudion been requested on
property for wrrent yeaf? ❑ Yes� No
20 L 20 O$ 0 9
.�
d P P
certify under the penalty af perjury that the above and foregoing information is We and corred and lhat the applicants was ! were
lent of Indiana and owner of the aforementioned property on March 1, 20
�re o ners full na ) - Persan authorized by duly executed Power of Attomey
� � '� . ) �� �� or by IC 6-1.1-12-.07
Full resident addre,E� of applicant _ � �Address of authorrzed person