HomeMy WebLinkAboutMortgage_MoodySTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS --
' ' FOR DEDUCTION FROM ASSESSED VALUATION , Coun" Ir{ To�w�ship) Year
S µ�� � State Fortn 43709 (R4 / 16-01) � �� ci i
� PrescribeA by Depanment d Local Govemment Finance
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INSTRUCTIONS: � W FileMarli�
To be filed in person or by mail with the County Auditor of the county whe2 the property is located:�.�.-ti�J, ��-�^-1�'
Filing Dafes: 1) Real Propedy: Dudng the 12 monfhs befo2 May 11 of the year the deduction is to:be�effecfive.�T'i AUDfTOP.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 31 0( the year the deduc[ion is to be ef/ective.
See reverse side /or additional instn�ctions and qualifications.
Applicant (own or contract buye,.r,/-�see s rictions reverse si
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Taxing Dist Key number / legal descriplion ec d number
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Q^ Page number
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Asses value of real properiy as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
Mar , current year March t, cunenl year owneR [j'�es ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on rewrd is differeni than that of applicant, indicate below: Is� th�e property in question:
�eal Property ❑ Mobile Home pC 61.1-�
�ame of mortgagee or contrad seller �
Address of mortgagee or conUact seller (number d 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 District? Has this dedudion been requested on
county in Indiana? property for cunent yearl �] Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
zo �_ 2o zo � zo �( 20 �� zo �� zo Si�
P o P
Signalure County Auditor Date
i/ We ceAify under the penalty of perjury that the above and foregoing infortnation is true and conect and that the applicants was / were
� resident of Indiana and owner of lhe a(orementioned property on March 1, 20
Signature (owners /ull name) Person authorized by duly executed Power of Attomey
— ' � � or by IC 6-1.1-12-.07
F resident address of appliqnt Address of authorized person
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