HomeMy WebLinkAboutMortgage_Simon`° �" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' = FOR DEDUCTION FROM ASSESSED VALUATION ow Year
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�, � Slate Form 43709 (R4 / 70-07)
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.� PrescribeO by Depanmenl W Local Govemment Finance
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INSTRUCTIONS: � File Mark
To 6e filed in person or by mail with the County Auditor of the county where the property is lo�ed. �
Filing Dafes: 1) Real PropeRy: During the 12 months be(ore May 11 of the year the deduction ''Fb�be-�Ae v� �
2) Mo6ile Homes assessed under IC fsf.l-7: Between January 15 and March 31 of t r�qe�ar�e deduclion isPio be eHective.
See reverse side Ior additional inst�uctions and qualifications.
Applicant (owner or contract buye �ee restrictions on reverse side) •
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Taxing Dislrid Key number / Iegal description Record numbe� a'� aQ g
���L�C�t/ Q��J — �G / c� 7—� Page number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, wrrenl year � 31� �pp owne(? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Pnoperty ❑ Mobile Hmie (IC Gt.1-�
�ame of mortgagee or contrad seller Jc/3
Address of moAgagee or conlraIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
counly in Indiana? property for current yeaf?� Yes� No
COUNTY AUDITOR
Oeduction approved in the amount of:
20 � s 20 O`' 20 20 __�__�ii 20 20 �� 20 �
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Signature County Auditor Date
1/ We certify under the penalty of perjury that the above and foregoing infortnation is lrue and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
S�qq ture ow ers name) Person authorized by duly executed Power of Attomey
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Fuli r sident address of applicant �{�639 Address of authorized person
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