HomeMy WebLinkAboutMortgage_Rogers�EMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
DEDUCTION FROM ASSESSED VALUATION
tate Fortn 43709 (R4 / 70.01) ,
Prescribetl Dy DepaNnenl of Lotal Govemment Finance
Coun Township Year
� �� �
� � le Ma�-j
filed in person or by mail with the County Auditor of the county where the propeRy is located. � � 1'LJ
Dates: i) Real Property: During the 12 months 6elore May 11 of the year the deduction is to be eHectivp.Co
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year the�d8dhct�or�r is,�(� eHective.
See reverse side for additional instructions and quali�catlons.
Applicanl
Taxing District
confract
on reverse
Key number / iegal description v I Record number ��
� I� -�3a 3� C.(J Page number �
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March i, curtent year March 1, rtent year owneR ❑ Yes ❑ No
I �y. �
If no, what is his / her exad share of interesl? If owned with someone otfier than spouse, indicate with wnom.
name on record is different ihan that of appticant, indicate below:
of moRgagee or contrad seller
Address of moRgagee or contract seller (number and street, city, state,
assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own propeAy in any other If yes, what county? What Taxing Distrid?
county in Indiana?
Deduction approved in the amounl of:
20
Signature
�
�
COUNTY AUDITOR
20 � 20 �� 20 �
� P
County Auditor
Is the property in question:
❑ Real PropeAy ❑ Mobiie Hortie pC 61.1-�
Has this deduclion been requested on
property for curtent yea(? � Yes � No
20 �� 20 �
P �°
/ We certify under the penalty of perjury that the above and foregoing infortnation is irue and correct and that the applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person