HomeMy WebLinkAboutMortgage_Mattix`OR�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. M� J S�ate Fortn 43709 (R4 / 70.01) �
�I Prescribetl by Departmenl of Loral Govemment Fnance
INSTRUCTIONS: � �� � Fi' Mark
To 6e filed in person or by mail with the County Auditor o( the county whe�e the prope is lo �
Filing Dates: 1) Real Prope�ty: During the 12 months betore May 11 0/ the year the deduction is Q b� effe�t�xg�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 �Be �e�r l��eduction is to 6e eHective.
See reverse side for additional insbuctions and qualifrcations.
I value of real property as of
current year
If no, what is his / her exact share of interesl?
on
Key number /
Mortgage / Cont
March 1. current
If name on record is different than that of applicant, indicate below:
,me of mortgagee or contract seller
Address of mortgagee or contrad seller (number and street, c,�
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP
Does applicant own property in any other If yes, what county?
counfy in Indiana?
Dedudion approved in the amount of:
20 Q,� 20 20
� Q f�""�
Signature
number
number � �
> unpaid as o Is the applicant the sole legal or equitable
�S ownef� ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
s the property in question:
❑ Real Pmperty ❑ Mobile Home (IC &1 _1-�
ZIP
What Taxing Distrid? Has this dedudion been requested on
property for currenl year?� Yes❑ No
COUNTY AUDITOR
20
County Auditor
20 �� I 20 �� I 20 �_
We certify under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power oi
or by IC 6-1.1-12-.07
FuII resident address of ap�cant Add
S�R+ I 8ox �a 9 i�� ��s+ad� ��l b3
person