HomeMy WebLinkAboutMortgage_Beloatje� n"' � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'� ;�� FOR DEDUCTION FROM ASSESSED VALUATION u To i Year
w� J State Fonn 43709 (R6 / S-06)
� Presaibetl by Department of Lopl Govemment Finance
n
INSTRUCTIONS: � Fi�Maric
To be filed in pe�son o� by mail with the County Auditor ot the county where the property is located. a-1 �, '
Filing Dates: 1) Real Property: Dunng the 12 months before dune t i o( the year the deduction is to ��8cti}�e� ,��
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Marc6 2 0l the year tFie r7e��i�n�i�Fl��Bective.
See �everse side for additional instructions and qualifications.
Applicant
Taxing Distrid
see
Assessed value oireal�roperty as of
March 1, current year
If no, what is his / her exad share of interest?
If name on record is different than ihat of
on
Key number / legal
Record number Q �
Page number � � �
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year o owne(? ❑ Yes ❑ No
a�� �3a,5co:�
�
If owned witli someone other than spouse, indicate with whom.
below:
�me of mortgagee or contrad seller
Q.n 13, �
Address of mortgagee or conVad seiler (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6erand street, city, state, ZIP
Does applicant own property in any other I If yes, what county? What Taxing Distrid?
county in indiana?
Deduction appro� ed in the amount ot:
20 � �_ ( 20 �
�
Signature
COUNTY AUDITOR
20 Q� 20 20
P
County Auditor
s lhe property in questian:
❑ Real Property ❑ Mobile Horne QC 6�1.1-�
- y'�
Has this deduclion been requested on
property for current yeaf? � Yes 0 No
20
20
We certify under the penalty of perjury thai the above and foregoing information is true and corred and that the applicants was / were
resident ot Indiana and owner of the aforementioned property on March t, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
person