HomeMy WebLinkAboutMortgage_CombsR�° STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' , FOR DEDUCTION FROM ASSESSED VALUATION
S J Slate Fortn 43709 (R4 ! 10-01) �
�a.
� Prescribetl by DeDartment of Local Govemment Finance
INSTRUCTIONS: � � �. E��le. M�
To 6e filed in erson or b mail with the Count Audifor of the coun whe2 the ro e 1L
p Y y ty p p rty is locat
Filing Dates: 1) Real Property: During the 12 monfhs be(ore May 11 oI the year the deduction is to be ��/iv� ��D03
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the yeaf��ilie e u ion �s to be eflective.
See reverse side /oradditional instructions and qualifications.
Applicant (owner or contract buyer - see restrictions on reverse side)
Distrid
March t
of real properiy as of
year
no, what is his / her exact share of interest?
If name on record,is different than that of
of moRgagee or contrad seller
Address ot mortgagee or contract
Key
ber / legal description
oo�l - ��1b3�D
Mo�qage / Contrad ir
March 1, current year
as
Record number
Page number
Is the applicant the sole legal or equitable
ownef? � Yes �tJo
D� I
If owned wilh someone other lhan spouse, indicate with whom.
�� �• \� .����
_ .•i• �
� �
��� , a- i '
�i��A
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other I If yes, what county? I What Taxing Distrid? I Has this deduction been requested on
county in Indiana? property for current yea(? � Yes ❑ No
Deduction approved in the amount of:
20
Signature
COUNTY AUDITOR
r� I .%' � \ - � �,
County Auditor
20 �_ � 20
Dale
�
We certify under the penafly of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Address of authorized person