HomeMy WebLinkAboutMortgage_Denboe�rt'n t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i+�-° : FOR DEDUCTION FROM ASSESSED VALUATION
�, �/ State Form 43709 (R4 / 1401) .
Prescribed by DePaMent of Local Govemment Fnance
INSTRUCTIONS: � � _
To be filed in person or by mail with the County Auditor o1 the county whe�e the property is lo ed. 9�(�
Filing Dates: 1) Real P�operty: During fhe 12 months 6e/o2 May 11 olthe year the deducti�to�Qef/c'c�fZe.
2) Mobile Homes assessed under IC 6-1.1-7: BeM1veen January 15 and March 31 of the yea the de ucl� n is to be eflective.
See reverse side (or additional instructions and pqualifrcations. J� 4 tl /
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Applicant
Taxing Distrid
buyer-see
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Assessed vatue of real property
March t, wrrent year
description I Record number O
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of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March�rrent year owneR ❑ Yes ❑ No
If no, what is his / her exact share of
/DOO �
If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
me of mortgagee or contrad seller
Address o( mortgagee or contreq seller (num r and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6erand st�eet, city, state. ZIP code)
Does applicant own property in any olher I If yes, what county?
county in Indiana?
Deduction approved in the amount
20 Q�
Signature
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What Taxing District?
COUNTY AUDITOR
20 O� 20
V
County Audilor
; the property
❑ Real Property ❑ Mobile Hane QC 6-1.1-�
Has this deduclion been requested on
property for wrrent year? � Yes ❑ No
20 D i� 20 0 T
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' We certify under the penalty of perjury that the above and foregoing information is true and corred and ihat the applicanis was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
full
duly executed Power of Attorney
or by IC 6-1.1-12-.07
Address of authorized person
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