HomeMy WebLinkAboutMortgage_Haley (3)��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'a�!'.���$�I; FOR DEDUCTION FROM ASSESSED VALUATION u s ip Year
"•.��J • State Fwm 43709 (R6 / 5-06)
� Presaibed by Depariment of Local Gwemment Finarice �QOg
INSTRUCTIONS: ��
To be filed in pe�son or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months 6efore ,lune 11 0/ the year the deduction is to bPy�6L�0UNTY AUDR�R
2) Mobile Homes assessed under IC 6-1.1-7: Belween January 15 and March 2 0/ lhe year the deducUon is to be e(fective.
See reverse side fo� additional instnictions and qual�cations.
Applicant
6uyer
0
Assessed value of real property as of
March t, current year
no, what is his / her exad share of interest?
on reverse
Key number / legal descripTion F
� �/9-3 s�. yoo -aoo. F
'�/ a -o a-
Mortgage / Contrad indebtedness unpaid as of
March 1, wrtent year
/i7, 97��5�
If name on record is different than that of applicant, indicate below:
�e of mortgagee or contrad seller •
number �OO p
0
number
ownef?
3 9 lP
t the sole legal or equitable
❑ Yes ❑ No
I( owned with someone other than spouse, indicate wilh whom.
Address of mortgagee or contract seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and
❑ Real Pmperty � Mobile Hmie pC Frt.
Dra�t�er NO.. �•CJ� ' \
state, ziP�ae� Card i\'O. ,,,,3��
� i7�r,9 a�: sv..
Does applipnt own property in any other If yes, what couniy? I What Taxing District?
county in indiana?
Deduction approved in the amounl of:
20�_ 20
P
Signature
COUNTY AUDITOR
20 20 20
County Auditor
Has this dedudion been requested on
property for cunent yea(? � Yes ❑ No
20
Date
�
certity under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
ient of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly execuled Power of Attomey
or by IC 61.1-12-.07
Address of authorized person