HomeMy WebLinkAboutMortgage_AzzarelloSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� S � / State Form 43709 (R5/4-03)
�� Presai�ed by Department of Lttzl Guvemmen� Finance
INSTRUCTIONS:
To be filed in person or by mail with the CounryAuditor of the county where the propeRy is located. —
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ the year the deduction is to be eflectiv�e �/ ��,n��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year fhe de�Jcti n to'De�effective.
See 2verse side lor additional instiuctions and qualifications.
�lc� ,G�,
(owner or contrac�eh- see
1
Taxin ey number / legal descriplion F
V"G� - BO - / 0�� f
� l
Assessed value af real property as o MoRgage / Contrad indebtedness unpaid as of
March 1, current year March 1, current year
what is his / her exact share of interesl?
I(
If name on record is different than that of applicant, indicale below:
�e of mortgagee or contrad seller
Address of mortgagee or contract seller (number and st2et, ci�
Name 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?
counfy in Indiana?
Deduction approved in the amounl of:
20
Signature
20
tl�nCmber G �
�.
number � �
Is the applipnt the sole legal or
owneR ❑ Yes ❑ No
with someone other than spouse, indicate with whom.
r
Whal Taxing District?
COUNTY AUDITOR
20 � 20 20
P
County Auditor
Is the pr
❑ Real
0
❑ Mobile Home (IC E1.1-
Has this deduclion been requested on
property for wnent year? � Yes ❑ No
20
20
certify under the penalty of perjury lhat the above and foregoing information is true and corred and thal ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March t, 20
ue (owne/s full name) Person authorized by duly executed Power of Attomey
�����t. �i�✓.�� n� o� by ic s-i.i-�2-.0�
�id�ni address of a�plicant Address of authorized person