HomeMy WebLinkAboutMortgage_Rugglesti�
� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
: w� / State Fom: 43709 (RS / 4-03) �
� Presai0ed by Department of Local�Govemment Finance �
Coun Township Year
INSTRUCTIONS: File Mark,Os
To be �led in person or 6y mail with the CountyAuditor ot the county where fhe property is located. MAY 3 LU
Filing Dates: 1J Real Property: During the 12 months belore May 11 0/ the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the ded�tion '�s'ta�.6e effective.
o °� �
See reverse side for additional instructions and quali�cations. G�gSON COUNTY AUDITOR
(owner or contiact buyer
Taxing
on rev�rse side)
number / legal desuiplion � Record number
C7�� W 7�OC � 70 � LJ Page number � �
Asses d value of real property as of Mortgage / Contrad indebledness unpaid as of Is lhe applicant the sole I gal or i
March 1, wrrent year March 1, ciurent year owner? �1'es ❑ No
�Q� � �_
If no, what is his / her exac[ share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan lhat of applicant, indicate below: Is the property in queslion:
morigagee or contrad seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or
Address
owner or holder of mortgage
and sheef, city, state, ZIP
Does applicant own property in any other I If yes, what county?
county in Indiana?
Deduction approved in the amount oC
20 c�7 20_Q�
P �
Signature
20
ti
❑ Mobile
Dra�ver NO. D y'.3 �� 9
I f�
COUNTYAU Card\0 ......................
20 20 20 20
County Auditor
61.1-�
quested on
� Yes❑ No
We certiy under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�esident of indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly ezeculed Power of Attomey
or by IC 6-1.1-12-.07
of applicant �Address of authorized person