HomeMy WebLinkAboutMortgage_Deal�' STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�. w� ♦ Stata Fwm 43709 (R5 / 4-03)
PrescriOed Gy Depanment ol local Govemmant Finance
Coun Township Year
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�R�cr�oNS: 9EC 1 pF�A�,�
� e �led in person or by mail with the Counry Auditor of the county where the property is located:
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deducfion is�to be eBective. �j � n
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 otjftve'yearthe deduchon.isLio.be-e(fective.
See reverse side for additional instructions and qualifications. GIdSON Cburli v nuDiTOR �
Applicant
buyer-see
Taxing District
Q,�Q�c�,Q�a�
Key number / legal description
Di� -�i�� - Ud
Assessed value of real property as of Mortgage / Contracl ii
March 1, current year March 1, curtent year
If no, what is his / her exact share of interest?
If name on record is different than that of applicant, indicate be�ow:
Name of mortgagee or contract seller
of mortgagee or contract seller (number
Name of assignee or other owner or holder of mortgage
as
�a o�
Record number
. oy-9
Paae number
Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
city, state, ZIP
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any oiher If yes, what counry? What Taxing District?
county in Indiana?
Deduction
20
Signature
COUNTY AUDITOR
in the amount of:
20 20 � 20 20
� P
Counry Auditor
s the property in questian:
❑ Real Property ❑ Mobile Home (IC E1.1-7)
Has this deduction been requested on
propertyforcurcentyear? ❑ Yes❑ No
20
0
20
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and lhat the applicants was I were
a resident of Indiana and ovmer of the aforementioned property on March 1, 20
(owner's full
��-N G�VI
O� �/ �.�r�f S
executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person