HomeMy WebLinkAboutMortgage_Ballard (2)a°'rt'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i-" � FOR DEDUCTION FROM ASSESSED VALUATION
; ��' State Form 43709 (R4 / 10.07)
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� Prescribea by Department of Local Govemment Finance
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INSTRUCTIONS:
Count Township Year
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To be filed in person or by mail with the County Auditor o/ fhe county where the propeRy is located_ G �OZ
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0l the year the deduction is to be e echve. ��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the y r the d uc on is'to be ect'
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See reverse side foraddifional instiuctions and qualifrcations. GI850N COUr�� D!TOR ,
Applicant (owner or cont t b yer - see restricti n re se ide)
Taxin Distrid Key number / legal description Record number
�Qn��f� age number
(% ((J
Ass ed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
If no, what is his / her exact share of inlerest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different lhan lhat of applicant, indicate below: is the properiy in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
��e of mortgagee or contract seller /� ("�
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Address of mortgagee or contrad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has lhis deduclion been requested on
county in Indiana? property for current yeaR � Yes � No
COUNTY AUDITOR
Deduction approved in the amounl of:
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Sig lure County Auditor b 9 Date
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�W certity under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
: ident of Indiana and owner of the aforementioned property on March 1, 20
ature (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ul i nl ad ss of ap ican Address of authorized person
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