HomeMy WebLinkAboutMortgage_Reinbrecht�e��"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION
'. ,«. ! State Form 43709 (R6 / S06)
Presaibed by Depertment of �ocal Gwemment Finance
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INSTRUCTIONS:
To be filed in person or by mail wifh the County Audito� of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months 6efore June 11 of the year the deduction is to be eff�uAv�. 1 S ZOO�
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 2 of the year the deduction is to be elfective.
See �everse side for additional insfructions and qualifications. ,Q
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/� r,iRSON C � TY AUDITOR
Applicant(ownero�cgr+ c uyer-see
/
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Taxing District
Asses d value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
on rey�rse side)
Key number / legal
number � � /�
7.,
a(�-a,3��-3oo-CX�I. �06 mber � 3` `'
7�
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or e
March 1, wRent year owner? ❑ Yes � No
� �9ooc� �o a �.
owned with someone other than spause, indicate with whom.
If name on record is different than that of applicant, indicate below:
oi mortgagee or contract seiler
Address oi moRgagee or contract seller (number and street, city,
of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
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Does appli �
county in I j Dra�ti•�r �ip 2 0 o cJ_ ����
3 Card i�ip — —
ZIP
Taxing District?
' "• • COUNTY AUDITOR
, .......
I/ ,�/ ......
Deductio � ` /`� �j ��� )
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20 �`L 20
P
Signature
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20 � I 20 I 20
County Auditor
❑ Real Property O N1otMle Home
property for wrrent year?
20
20
G1.
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I I We certify under the penaity of perjury that the above and foregoing infortnation is We and correct and that the applicants was 1 were
�sident oi Indiana and owner oi the aforementioned property on March 1, 20
�ure (oivrters ruu name �/��� ,^^
� A N/��
U/C (l( X�/ `
F II resident address oi appticant
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Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
Address ofauthorized person