HomeMy WebLinkAboutMortgage_Carpenter (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� � State Form 43709 (R3 ! 10-00)
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� Presaibed by Stste Board of Ta�c Commissioners
InsWctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional insWCtions and qualfipGons.
FORM 5
SEP 17 2001
�IB/�4TY AUDITOR
Appli r or contract buy - ee restncti on 2verse side)
Taxing istri Key numb / legal description Record number O/
�r/�„ �, 1 ^„� _ O�� ^� Page number • �/ ��
l (.(�CJiC �.G<J ��CJ
Assessed value of real pr erty as of Mortgage / Contred indebtedness unpaid as of Is the applipnt the sole legal or equitable
March t, current year March 1, current year owneR ❑ Yes ❑ No
. . a5 00� .
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is d'rfferent than that of applicant, indicate below:
�� of mortgagee or contraG seller
Address of moAgagee or contrect seiler (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and street, aty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing Distrid? Has this dedudion been requested on
other county in Indiana? properry for current yea�? � YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
oti
2o zo zo 20 5� 20 0 G 20 20�� 0�
5 � �- -� P P � �
Signature County Aud'Ror Date
�e certify under the penalty of perjury that the above and foregoing informaGon is We and corted and that the applicants was / were
�dent of Indiana and owner of the aforementioned property on March 1, 20
Signature (o rs full name) Person authorized by duly executed Power of Attomey
or by IC 61.1-12-.07
Full resident dr of appli n Address of authorrzed person
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