HomeMy WebLinkAboutMortgage_HippSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
- • FOR DEDUCTION FROM ASSESSED VALUATION - n i Townshi{j� vear
µ�� � State Form 43709 (R4 / 10-Ot) ' o � . � �
� PrescribeE by Depannrent ot Loral Govemment Finanre �
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INSTRUCTIONS: ' /�
File IXAark ��% �/
To be filed in person or by mail with the County Auditor of the county where the property is located J�� I
Filing Dates: 1) Real Property: Dunng the 12 months betore May 11 0l the year the deduction is to'be eltBCtive:OU'!TV .q��pITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 31 0l the year the deduction is to be eHective.
See reverse side for adddional instructions and qualifrca6ons.
Applicant (owneror conhact buyer- see restrictions on rev�rse side)
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Taxing Distrid Key number / legal de 'ption Record number
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Page number
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Ass sed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
Mar 1, current year March 1, currenl year ownef? �es ❑ No
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If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is diiferent than that of applicant, indicate below: Is the property in question:
eal PropeAy ❑ M�ile Home QC Fr7.1-�
'ame of mortgagee or contrad seller
Address of moR gee or conVad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other if yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curcent yea(? � Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount of:
zo � io zo 2o a� zo 0 7 io Q� zo o�
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Signature County Auditor Date
�1/ We certify under lhe penalty of peryury lhat ihe above and foregoing information is true and corred and lhat ihe applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
Signature (owne/s full name),/ Person authorized by duty executed Power of Attomey
U� � ,[Lf or by IC 6-1.1-12-.07 �
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F I resident address of appli �QGh r�,� Address of authorized person
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