HomeMy WebLinkAboutMortgage_Williams (7)�i'�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'� FOR DEDUCTION FROM ASSESSED VALUATION ou o ip Year
(��% State Fortn 43709 (R6 / 5-06)
� Presaibed by Department of Loral Gwemmem Finance
JUN �
INSTRUCTIONS: �7j2_ �1ark
To be �led in person or by mail with the County Audito� of the county whe�e the propeRy is locat�R f d
Filing Dates: 1) Real Property: Dunng the 12 monfhs before ,lune �7 0/ fhe year the deduction is to�b���l�'c�TY AUDITOR
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 o/the year the deduction is to be eBective.
See �everse srde for additional instnictions and qualifications.
Appli nt (owner or contract buyer- see res rictions on reverse side) -
Taxing Distrid Key number / legal description Record number
� �-�3-i3-.� -uoi.o9a-m Pagenum er — ��, -
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the soie legal or equitable
March 1, curtent year March 1, current year owne(? ❑ Yes ❑ No
�
If no, what is his / her exact share of interest? If owned with someone olher than spouse, indicate wilh whom.
If name on record is diHerent than that of appliwnt, indicale below: Is the property in queslion:
eal Property ❑ Mobile Home QC 61.1-�
e of mortgagee or conirad seller
— � .
Address of moRgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for cunent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 �_ 20 20 20 20 20
� P �
Signature County Auditor Date
�We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Sign e(owners /ull name Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Futl resid nt addres� app i 4 �g O�� Address of authorized person
� ��► -