HomeMy WebLinkAboutMortgage_Sauer`°rt��° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
a�° � FOR DEDUCTION FROM ASSESSED VALUATION
�, �y S�ate FOrm 43709 (Ra / 10-01)
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Prescribe0 by Departnent ol Local GovemmeN Pinance
Count Township Year
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INSTRUCTIONS: File Mark
To 6e filed in person or by mail with the County Auditor o( the county whe2 the propeRy is located_
Filing Dates: 7) Real Property: Dunng f6e 12 months be7ore May 11 0/ the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0( lhe year the deduction is to be effective.
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See reverse side (or addifional inst�uctions and qualifications. ����
Applicant (owner or contracf
Taxing
Key number /
OCT 15 2002
O/� ^O 0 Pa9enum - __.._.. .
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Ass sed value oi real property as of MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
If no, what is his / her exact share of
name on record is different lhan that of applicant, indicate below:
of mortgagee or contract seller
Address of mortgagee or contract seller (number and street,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
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If owned with someone other than spouse, indicate with whom.
ZIP
Is the property in question:
❑ Real Properly ❑ Mobile Hane (IC 61.1
Does applicant own property in any olher I If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? properiy for current year? � Yes � No
Deduction approved in the amount of:
20 �1,� 20 D 20 ��!
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Signature
COUNTY AUDITOR
20
County Auditor
r� �
20 ��
P
Date
20 �
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We certify under the penalty of perjury lhat the above and foregoing in(ormation is true and corred and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authurized by duly executed Power of Attomey
or by IC 6-7.1-12-.07
of authorized person