HomeMy WebLinkAboutMortgage_Carey (2)� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship vear
� / Slate Form 43709 (R4 / 10-01)
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� Prescribed by DepanmeN W Loral Govemment Finance
INSTRUCTIONS: APR `� �
To be Bled in person or by mail wifh the County Auditor ol the county wheie the prope�ty is located.
Filing Dates: 1) Real Property. During the 12 months be/oie May 11 0/ the year the deduction is to eHective. In/
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ tA year th d �oction is to.tr�ee��ctive.
See reverse side for additional instructions and qualifications. GIBSOtJ CJOU��i v AUDI?OR �
Appli nt erorcontract buy r- e restri 'ons on reverse )
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Taxing Dist Key number / legal descripC Record number
03
� /Q � ' M/ - fj � //_ 2 �l Page number � � �
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Assessed value oi real property as of Mortgage / Cantrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year J��� �'� � owneR ❑ Yes ❑ No
7
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is difierent than ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hane pC 61.1-�
�ame of mortgagee or contrad seller ,
Address ot mortgagee or contrad seller (number and street, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage .
Address of assignee (number and street, city, state, ZIP cc O�u3 - a�90 '
Dra���er NO ................... I �
Does applipnt own property in any other If yes, what cour u'r"^' �� .101 �(p.�i� �%dudion been requested on
county in Indiana? 81'd NO�,,,.+ ...... �r current year? � Yes O No
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COUNTY AUDfTOR
Deduction approved in the amount of:
20 20 � 20 � 20 20 t7� 20 20
� � � p � �
Si nature County Auditor Date
��/ We certify under lhe penalty of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementloned property on March 1, 20
Sign�ture� (o�w�ner�s (�u��ll nam Person authorized by duly executed Power of Ariomey
A I I�IYy 1 I (� or by IC 6-1.1-12-.W
I ��Jil ��l'l
F II resident address of applipnt Address of authorized person
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