HomeMy WebLinkAboutMortgage_Weber (4)�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
° = FOR DEDUCTION FROM ASSESSED VALUATION o hTo'wn' ip Year
�. � / Stale Fortn 43709 (R4 / 10.07 ) ' .
�«• prescnEeA by DepaM�ent of Local Govemment Finance �� '
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INSTRUCTIONS: /� F�1e Mark
To 6e filed in person or by mail with the County Audiror of the county whe2 the property is locafeb! 7�. -
Filing Dates: 1 J Real Property: During the 12 mont6s be%re May 11 0) the year the deduction is t�tie`,e��ch�� ��� �+U��T�F -
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the year the deduction is to 6e eNective.
See reverse side for additional instiuctions and quali�cations.
Ap licant (own r or con ct 6uye - see restrictions on reverse side) ,�
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Taxing Distrid Key n b r/ legal description Record number
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OI 3-c� 5 a a—� Page number
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, curtent year March 1, current year owneR ❑ Yes � No
50vaG
If no, what is his / her exact share of interest? If owned with someone ofher than spouse, indicale with whom.
If name on record is different Ihan Ihat of applicant, indicate betow: Is the property in question:
❑ Real PropeAy ❑ Mobile Home (IC 6�1.1-�
�ame of mortgagee or contrad seller� � ^
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Address of mortgagee or contract seller (number and streef, city, state. ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and sUeet, city, state, ZIP code)
Dces applicant own property in any other If yes, what county? What Taxing Dislrid? Has this dedudion been requested on
county in Indiana? property for wrrenl year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �3 zo �_ zo zo � zo �.,Z zo � zo �
� d� �' P P �P
Signature County Auditor Date
I/ We certify under the penalty of perjury lhal the above and foregoing infortnation is true and corred and that lhe applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
i ture (o r�r full a ) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull resident address of applicant Address of autho�zed person
as" y S� ��' f/qy,tss��lo r�