HomeMy WebLinkAboutMortgage_Williams (21).�.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S M� � State Fwm 43709 (R5l 4-03)
� PmscnDeC by Department of Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1J Real Property: During the 12 montbs before May 11 o/the year the deduction is to be(�ef{ectiSe. ZOO4
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0///! ���the year the deduction is fo be eHective.
See reverse side for additional instructions and quali�cations. /�� J�� �/�
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Applicant (owne� or contract buyer- sge�restridions on
/ legal descriplion � Record number
D/� _O 0/ 2 g—O O Page number q/-7 �
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the appliwnl the sole legal or equitable
March 1, current year March 1, cunent year owneR ❑ Yes ❑ No
If no, what is his / her exad share of interest?
If name on record is difterent than lhat of applicant, indicate below:
'ame of mortgagee or contraIX seller ��
Address of moAgagee or contrad seller (number and street, city, s
of assignee or other owner or holder of mortgage
of assignee (number and street, city, state,
Does applicant own property in any other If yes, what county?
county in Indiana? '
_ __
Deduction appro� Drawer NO......
� Card NO. , L'''`�—.��
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Signature
County nuanur
If owned with someone other than spouse, indicate with whom.
What Taxing Distrid?
iY AUDITOR
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Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.
Has this dedudion been requested on
property for current year7 � Yes ❑ No
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Date
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/ We certify under the penalty of peryury that the above and foregoing information is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Si nalur (�wner's Iull n
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Full reside address of
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Person authorized by duiy executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person