HomeMy WebLinkAboutMortgage_Stoll�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� / State Fortn 43709 (RS / 4-03) G�
�«. �
� Pfescnbetl Ey Department of Local Govemment Finance � !
�/\� . _` —+ ' `_1
INSTRUCTIONS: � -, File Merk�
To 6e filed in person or by mail wftA the County Audifor o/ the county where the property is located. � �� s�
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is to be e/%cfive.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year fhe�deduction�isQolp� effective.
See reverse side for additional instructions and qualifications. � //
� � �/
,�,�,.. �-, •'� _ : �,_ [ . , 1/
v_�-�
Applicanl (ovmerorcont t uyer- see restnctions o ver�e side) • �""'""• `""'..' '.'�".."" '
�.r. _
�TV t./Yl
Taxi Distrid Key number / legal description Record number /^,�.�
U
/j'�Q � � O � r�� Page number /j,�
v J ��
Asses d value of real property as of Mortgage / Conlrad indebtedness unpaid as of is the applicant the sole legal or equitable
March 1, curcent year March 1, current year owneR ❑ Yes ❑ No
�� .
Ii no, what is his / her exact share of inlerest? If owned with someone other than spouse, indicate wilh whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Pmperty ❑ Mobile Horne pC Cr1.1-�
�''ame of mortgagee or contreIX seller <�
J
Address of mortgagee or contrad selier (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, Zlf
Does appliwnt own property in any olher If yes, what Dra`yer �'O.,O�� q/} �'s dedudion been requested on
county in Indiana? Car �' �/., 7� ly for wrcent yea�? � Yes❑ No
d 1�p .
....... -
Deduction approved in the amount of:
20 � 20 20 20 � 20 Qg 20 � 20
T -�
Signalure Counry Auditor Date
�/ We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident Indiana and owner of the aforementioned property on March 1, 20
u (o ers full name) Person authorized by duly executed Power of Attomey
or by IC 6-t.t-12-.07
F esi ent address of applicant Address of authorized person
a3 E u� �