HomeMy WebLinkAboutMortgage_AllenSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
°+ �w J State Form 43709 (R5/4-03)
.�. Presaibe0 by Department of Local Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor o/ the county where the property is located. � p —� 2004
Filing Dates: 1) Real Pioperty: Dunng tbe 12 months 6efore May 11 oI the year the deduction is to 6e efl�cAve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 of the ear the deduction is to be effective.
See reverse side !or addi[ional instructions and qualifrcations �--� (a �„��� ��
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Applicant (owne� or con�d�f buyer -
Key number / legal description
(�O(� -�G�00
v
number
Page number
Rssessed value of real properiy as of MoRgage / Contrect indebtedness unpaid as of Is lhe applicant the soie legal or
March 1, current year March 1, current year owneR ❑ Yes ❑ No
��J�. �OC7
If no, what is his / her exact share of interesl?
If name on record is different than that of
of mortgagee or contrad
indicale below:
owned with someone olher than spouse, indicate with whom.
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state,
Does applicant own property in any other I If yes, wha
county in Indiana?
Deduction approved in the amounl of:
20
Signature
20 �
code)
Is the property in question:
❑ Real Property O Mobile Home (IC 61.1
-- I What Ta�cing Disirid? Has this deduction been requested on
property for current year?Q Yes� No
!
Dr �
Ca awer]�O C�(1[_ zL�'
rd N�
20 V l 20 ��
� f
County Auditor Date
20
/ We certify under the penalty of perjury lhat the above and foregoing information is true and corred and ihat the applicanls was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person