HomeMy WebLinkAboutMortgage_LoftonSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS --- ---
FOR DEDUCTION FROM ASSESSED VALUATION ��Wn '7 �y{,J,ow�ri�s�hipy,1 Year
♦ / State Fwm 43709 (RS / a-03) � �,�„ ,$.�f S�✓
� PresaiEeE by DepartmeM af Lo'..el Govemment Fina�e ,
.,�,� nn5
INSTRUCTIONS: F,ile.Mark
To be filed in person or 6y mail with the County Auditor of the county where the property is located. ��a� � t�
Filing Dates: 1J Real Property: During the 12 montAs before May 11 of the year the deduction is to beSe�EGtive�N7Y AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 o/th��ear the deduction is to 6e effective.
See reverse side for additional instructions and qualifications.
(owne�
Tauing Distrid
buyer-see
Assessed v�fue of real property as of
March 1, current year
If no, what is his / her exact share of
If name on
side)
Key num�r / legal
Record number
Page number
Gb�/-oo y�- �
Morfgage / Contrad indebtedness unpaid as of Is the ap�
March 1, cunent year owneR
than that of applicant, indicate below:
moRgagee or contreIX seller
iegai or
❑ No
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contraIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage __
Address of assignee (number and st2et, city, state, ZIP code)
Does applipnt awn property in any olher If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 �7
Signature
� i�
�
❑ Mobile Home
�—
,�2� - 5'�? `�
ra�r'er N""'-O� "` �
�
Card NO•
/ 9� COUNTY AUDITOR
20 20 20
County Auditor
20
ested on
,..a� � �J Yes� No
20
certify under lhe penalry of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20 '
— I Person authorized by duly executed Power of Attomey
(� or by IC 6-1.1-12-.07
�Address of authorized person
=���s�-