HomeMy WebLinkAboutMortgage_Mast�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Cou Year
�� �w� i State Fortn 43709 (RS / 4-03) � � a � � , . .
� Prescn6ed by Department of Local Govemment Finance
MAR 0 1
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. �j�
Filing Dafes: 1) Real Property: During the 12 montbs before May 11 of the year the deduction is to be e/�ct'� 'a
2) Mobile Homes assessed under.IC 6-1.1-7: Between January 15 and March 2 of the���rd���nuw,t�pbT9�effective.
See 2verse side foi additional instructions and qualifications.
Applicant nerorcontract buyer- s estn ions on rse side)
CL � � .
Tauing D' trid Key number / legal description Record number /
���.��� /�- <o
n `y-�� / /_� Page number
�/ VC/ l0
Assessed value of real property as of Morigage / Conlract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? ❑ Yes ❑ No
, �d ��
If no, what is his / her exact share of interest? if owned with someone other than spouse, indicale with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
` ❑ Real Property ❑ Mobile Home pC G1.1-�
�me of mortgagee or contrad seller --- _
� Dra�i�er NO. af�(p ��
...... ........
Address of mortgagee or contrad seller (numb and st�eet, city, state, :
Card 1To. .. ►�a9
Name of assignee or other owner or holder of morigage "" f•••�••••......
c� � SFJ SOo
Address of assignee (number and street, city, state, ZIP code) s`�"" ��q. ('p
a
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current year? �] Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 _�� 20 � 8 20 Q� 20 20 20 20
p P P
Signature County Auditor Date
Ne certity under the penalty of perjury that the above and foregoing informalion is true and correct and that the applicants was / were
.�esident of Indiana and owner of the aforementioned property on March 1, 20
Signateire' j rs ful ame Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
II esident address of appiicant Address of authorized person
��,�..� P �� �,��-��E � G�s