HomeMy WebLinkAboutMortgage_Conner (2)� � STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S� / State Fwm 43709 (RS / a-03)
RasaibeC by Depertment ot Local Govemment Finance
Coun Township Year
�RUCTIONS: File Mark
�� be filed in person or by mail with the CountyAuditor o) the county whe�e the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to be eQ�'
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea� d duG on is�e�ve.
See reverse side for additional instructions and quali(cations. ��• _� J
_ „ ��� .2 �nno
- see
Assessed value of real property as of
March t, current year
If no, what is his / her exact share of
If name on record is dif(erent than
Name of mortgagee or contract
on reverse
�mber / legal description I Record riugi6erN
D/3 _�� � � � Page number
Mortgage / Contract indebtedness unpaid as of I Is the a
March 1, current year owner?
%3 70e�o
of mortgagee or contract seller (number and
1•
%�i
c me soie iegai or eqw�a
❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
❑ Real
Name of assignee or other owner or holder of mortgage
street, ciN, state,
Does applicant own property in any other I If yes, what county7
county in Indiana? •
Deduction approved in the amount of:
�
Signature
zo
zo �
�
state, ZIP
What Taxing Districi?
DrawerNO.��� ••7•�'?'�'
Card NO . .....................
County Auditor
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❑ Mobile Home (IC E1.1-7)
Has this deduction been requested on
property for current year? � Yes❑ No
zo� zo
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Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applican[s was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
ar by IC 6-1.1-12-.07
ot authorized person