HomeMy WebLinkAboutMortgage_WyattSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
\ / S3ta Fwm 43709 (RS / 4-03)
�, Prescribetl by Departmem of Lotal .�,ovemmant Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county wheie [he property is located.
Filing Oates: 1) Real PropeRy: Dunng the 12 months before May 11 0/ the year the deduction is to b� �f(�cl�v� 2��6
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be eflective.
See reverse side for additional instrucfions and qualifications. �-yy�6� �Q
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�� _ . 1 . r_iaSON COUNiY AUDITOR
Applicant
District
Asses�d value of real property as of
March 1, wrrent year
If no, what is his / her exad share of interest?
If name on record is different than that
on
/ legal description
Mortgage / ContraIX ir
March 1, current year
indicate below:
Record number
' � Page number ^� � /' !
/ `"r y
unpaid as of Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
of mortgagee or contrad seller �
ss of mortgagee or cont�act seller (number and street, city, state, ZIP
of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
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pYa�ver -
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Ca
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Is the property in question:
❑ Real PropeAy ❑ Mobite Home QC G1
Taxing Distrid? Has this dedudion been requested on
property for current yeaf? � Yes ❑ No
COUNTY AUDITOR
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_ County Auditor
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! We certify under the penalty of perjury that the above and foregoing infortnalion is true and corred and that the applicants was / were
resident of Indiana and owner of lhe aforementioned properiy on March 1, 20 .
�wne/s /ull name) Person authorized by duly executed Power of Attomey
_ � �' �_ � � or by IC 6-1.1-12-.07
address of applipnt (/ � � �Address of authorized person