HomeMy WebLinkAboutMortgage_Young (5).�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSEO VALUATION
�+ / State Form 43709 (R5 / 4-03)
PresaiDeO by Department ol Laal Govemment Finance
` l "
. s:' , � � .. .
INSTRUCTIONS: "
Coun Township Year
� C ?i'+
r:i ._,�.
.. — -�`-✓ ,� . �/
��File• Mark
To be filed in person or 6y mail with the CountyAuditor of the county whe2 the property is located. � �� 1���U�
Fiiing Dates: 1J Real PropeRy: Dunng the 72 mon[hs 6e%re May 11 of the; year fhe;deducGon is to be e8e 1ive. � r
2) Mo6ile Homes assessed under IC 6-1.1-7: Betweeri January 15 anil March 2 of the year Hie:deductlon'is to 6e efiective. �
� /o _ ..i...:,r ,.
See reverse side for additional inshuctions and qualifications. _ �. _, �r Ur�"'"Y 'J =�ur; �I r q��Ui p�
� „ -13 ��: - .���;I �� v5� aa-i� - - -
Applicant (owner or contract 6uyer - see restrictions on reverse side) •_
� C
Taxing District —_ -. Key number / legal description Re rd number"
. — • -� :�'^,r' _ _
` Page number
O Z� 3 - o -a
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of � Is the applicant�sole legal or equitable
March 1, currenl year � � � March 1, current year " � owner? � es ❑ No '
If no, what is his7 her exact share of interest? If owned with someone other than spouse,-indicate with whom.
If name on record is different than that of applicant, indicate below: , Is the property in question:
. -- �• . ' ' E _ ... � � .
eal Property ❑ Mobile Home (IC E1.1-7)
�e of mortgagee or contract seller � � . -
_t', _ _ 't• � -or r� _. ' ."' _�._._ _ •-�� -
Address of mo gagee or contract seller (numb Name yOU��i OE�%�viSL' Ej„ A�E-
j
Name of assignee or other owner or holder of i DOCUllleilt �. �� _ ag� 5
, _ : �. Date ,
Address of assignee�(number and streef, o�ry, Bank _
Does applicant own property in any other If yes, what counry7 What Taxing District? • Has. this deductlon been requested on
county in Indiana? - _ � g�- ,^�- �?.-, • property for curcent year? ❑ YesO No
_ . . . _ - -rj:� ,. ;. .�
COUNTY AUDITOR " •
Deduction approved in the amount of:
20 �y 20 20 � 20 20 20 �� 20
� � �-e� og- P P
Signature County Auditor Date
�We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signat owners lull name) Person authorized by duly executed Power of Attomey
�'I �,,�,�, or by IC 6-1.1-12-.07
F. ull,{esi ent address of applicant Address of authorized person
\� Rk'� I aox ao�F OAKLANt� crTY