HomeMy WebLinkAboutMortgage_Cundiff (3)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. M� ♦ State Fortn 43709 (RS / 4-03) �� � � �;;i j
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� Presai�etl by Departmeni of Laal Govemment Finance � � �
INSTRUCTIONS: AUG �1e;��D3
To 6e filed in person or by mail with fhe County Auditor of the county where fhe property is located. �'
Filing Dafes: 1J Real Property: During the 12 months be%re May 11 0/ the year the deduction is to be �Rect� .� � n
2) Mobile Homes assessed under IC 6-L 1-7: Between January 15 and March 2 of the.y'ear•the�ded Jct on �s �o� T�ftei tive.
See reverse side for additional instructions and qualifications.
Applicant (ownerorcontract buyer- see restrictions on reverse side)
Taxing Dislrid Key number / legal descr' tion
� " —
Assessed value of real property as of Mortgage ! Contract indebtedness
March 1, current year March 1, currenl year
If no, what is his / her exaci share
name on record is different lhan lhal of applicant, indicate
of mortgagee or contracl seller
� Record number
3
Page number
� o ��
as of Is the applicant t e sole lega or
ownef? es � No
If owned with someone other than spouse, indicate with whom.
v ❑ Mobile Hane OC 61.
o( mortgagee or coniract seller (number and st2et, city, state, ZIP
Drawer NO..�� •••••••
Name of assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what county?
county in Indiana?
�
Signalure
Card NO. ... �?�7�••••••••
.� 94, SCO. oo —
"8�,�,�, '�4w� B°"'�C
What Taxing Uistnct? Has this deduction been requested on
I property for wrrent year? 0 Yes ❑ No
COUNTY AUDITOR
approved in fhe amount of:
� 20 D,S 20 Q(� 20 �� 20 ��
� � �
County Auditor
20 Q'L 20
f
Date
certity under the penalty of perjury that the above and toregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned propeAy on March 1, 20
e (owners (ull name)
0,-.�.�.5 l�-. G-
sident address of applica
�n+3 /5...,� 11
�
Person authorized by duly executed Power of Attomey
or by IC 6-1.7-12-.07
Address of authorized person