HomeMy WebLinkAboutMortgage_BlaizeSTATEMENT OF.MORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
ti � State Form 43709 (R4 / 10-01)
ia.
PresaibeO Dy Department W Loal Govemment Finance
��_ �' + �
- ,�—� -� � �
INSTRUCTIONS: t -9 F_ile Mark � �
To be filed in person or by mail with Ihe County Auditor of the county whe2 the property is located. �'- �- �J �� ���
Filing Dates: 1) Real Property: During the 12 months be%2 May 11 0l the year the deduction is to be effective. nn'
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0l the year the dedhbfib°n }� t� ��filctive.
See ieverse side /or additional instructions and qualifications.
(owner or contract
T nd
I \ /�J �
� .
Assessed value of real
March 1, current year
If no, what is his / her exact
see restrictions
as of
Key number / legal description �"�' R�cord numbe� O a�
00 - � � Page number � � / �
J
Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
i-��6 4
If owned with someone other than spouse, indicate with whom.
name on record is different than that of applicant, indicate below:
of moRgagee or contrad seller
Address of mortgagee or conVad seller (number and street, city, state, ZIP
Name of
or other owner or holder of mortgage
(number and street, city, state, ZIP code)
Does applicant own property in any other I(yes, what county? What Taxing Distrid?
county in Indiana?
COUNTY AUDITOR
Deduction approved in the amount of:
20
Signature
zo � 20 0 5 2a o 6
��a� � �
County AudRor
Real
❑ Mobife Home (IC 61.1
Has lhis deduction been requested on
property for curtent year? � Yes ❑ No
zo �� zo �._
� P
/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and thal the applicants was / were
lresident of Indiana and owner of the aforemenlioned property on March 1, 20
(owner full
— �
ull resident address of
,�R 3 �3ex ac
t
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
person