HomeMy WebLinkAboutMortgage_BlakeSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-- � FOR DEDUCTION FROM ASSESSED VALUATION
S J Slate Fortn 43709 (R4 / 10-01)
Prescribed by Department W Local Govemment Finante
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:
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county whe2 the property is located. � 6 20�L
Filing Dates: 1) Real PropeRy: During the 12 months be%�e May 11 of the year the deduction is to be eHect(��,�, 2
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Maich 31 0l the year the deduction yi��to b�e�
See 2verse side loradditional inst�uctions and qualifica6ons. � �. �../�
Distrid
�l� ��A /
Assessed value of real pr<
March 1, current year
as of
on raverse
Key number / legal description Record number o�
�0 %� O� /a�. / _�O Page number / �7
v 7� ��- �v
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
7O DOO
If no, what is his / her exad share of interest? If owned with someone olher than spouse, indicate with whom.
If name on record is different than that of appticant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horne pC 61.1-�
of moAgagee or contrad seller
of mortgagee or wntrad
of assignee or other owner or
(number and
mortgage
dty. state, ZIP
(number and st2et, city, sfate, ZIP code)
Dces applicant own property in any
county in Indiana?
Deduction approved in the amount of:
20
Signature
If yes, what county?
�'Ay' ' �
What Taxing District?
COUNTY AUDITOR
zo o � Zo
County Aud'Ao�
Has this deduction been requested on
propeAy for curtenl year?� Yes❑ No
20
Date
r� �•
We ceAify under lhe penalty of peryury ihat the above and foregoing infortnation is true and correct and that lhe applicants was / were
.resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owner's Iull name) Person authorized by duly ezecuted Power oi Attomey
�� "l.._ il /. `i_ or by IC 6-1.1-12-.07
address
Address of authorized person