HomeMy WebLinkAboutMortgage_Boes�u� � 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's'� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� �
�i' j State Fortn 43709 (R6 / S-06)
� M Presaibed by Department of Loml Govemment Finance
INSTRUCTIONS:
DEC 1 'l 2006 .
File Mark
To be filed in person or by mail with the County Auditor of the county where the prope�ty is loca e
Filing Dates: 1) Real Property: During lhe 12 months 6e%�e ,lune I t of the year the deduction is � aQ�e.�
2) Mobile Homes assessed under IC 6-1_ 1J: Befween January 15 and Marci����i����t��,d���l8a is to be eflective.
See ieverse side for addrtional instnictions and qualifications.
Applicant (own r or contract buyer- see restricUo s on reverse side
�f-
Taxing Dislri Key nu b 1legal description �"y� p Record number
p�(�//��-.�/-303-Q00. /35 -�/ Pagenumber
� - cJ -
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR �lfes ❑ No
If no, what is his / her exad share of interest? If owned with someone other thsn spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
�Real Properfy ❑ Mobile Home QC 61.1-�
�me of mortgagee or contract seller -
Address of mortgagee or conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wnent yeaf?O YesO No
COUNTY AUDITOR
Deduction proved in the amount of:
20 �_ 20 6� 20 0 Q 20 20 20 20
P P P
Signature County Auditor Date
�I / We certify under the penalty of perjury that the above and foregoing information is lrue and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned properiy on March 1, 20
Signature ners /ull n ) Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
Full r sid t dress f app icant Address of authorized person