HomeMy WebLinkAboutMortgage_Davis (13)rt�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' : FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S J S�� Form 43709 (R4 / 10-0i )
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� Prescribe0 by Depanmenl W Local Govemment Finance
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INSTRUCTIONS: � � �Fi��
To be filed in person or by mail with the County Auditor of the county where the property is located� �'� ���
Filing Dates: f) Real Property: Dunng the 12 monfhs 6elore May 11 0/ the year the deduction is to be eff��t[v,s. �� ��
2) Mobile Homes assessed �nder IC 6-1.1-7: Be(ween January 15 and Ma�ch 31 0/ the year�tl��be � o be eNective.
See reverse side for additional instructions and quali�cations.
Applicant (owner or
Taxing Disirid
buyer-see
Assessed value of real property�as of
MarcF� 1, wrrent year
no, what is his / her exact share of interesl?
on reverse side)
Key number / legal description � Record number
�DJ_ r„ �/ C/� _�ry� Page number ��/ �
rJ �7 L.i� �s
MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
�.�I
Ii owned with someone olher lhan spouse, indicate with whom.
If name on record is different ihan that of applicant,
� me oi mortgagee or wntract seller //�
G1 I
✓
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand stieet, city, state, ZIP
Does applicant own property in any other If yes, what county?
counry in Indiana?
Deduction approved in the amount of:
20
Signature
r � ,/
/
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What Taxing District?
COUNTY AUDITOR
20 _� 20 <� 20
� �
Counry Auditor
❑ Mobile Hortie
Has this deduction been requested on
property for wrrent year? � Yes❑ No
20 D �
�
Date
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' We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and thal ihe applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
(owners
�
Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person