HomeMy WebLinkAboutMortgage_Greere, "� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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��id�� FOR DEDUCTION FROM ASSESSED VALUATION u ns p Year
�.�� State Form 43709 (R6 / 5-06)
� Presaibed by Departmenl of Lonl Govemment Financa oo�
INSTRUCTIONS: `�-ij6���
To be filed in person or by mail with the County Auditoi o! the county whe�e the property is located. a
Filing Dates: 1) Real Property: Dunng the 12 months 6e/o�e June 11 of the year the deductron is to t�I�Hv�.0UN7Y AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is fo be effective.
See reverse side for additional instructions and qualilicatrons.
Applica '(ownerorcontra�uyer- se sMctions on verse side)
Taxin istrid Key number / legal descriplion Record number ��
� � // - � S- ,300 - DDO. Page number S .3 �
6- oa7 3
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, currenf year March 1, cunent year owneR ❑ Yes ❑ No
� 0� DOb
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 different than that of applicant, indicate below: Is lhe property in question:
❑ Real Prope�iy ❑ Mobile Hmie (IC 61.1-�
�me of mortgagee or contrad selier� _
Address of moRgagee or conlrad seller (number and sfreet, city, state, ZIP
Name of'assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
� �. 9.-.�s.3�
Does applicant own property in any other If yes, what county? DCa��eT ��' � requested on
counry in Indiana? �� Yes❑ No
Card NO . ....................
.
couNrr Ai
Deduction approved in the amount ot:
20 _Q� 20 �y_ 20 20 20 20 20
1 .
Signature County Auditor Date
' We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
. resident of Indiana and owner of the aforementioned property on March 1, 20
ignalure�nets (uIl name) Person authorized by duly executed Power of Attomey
' � or by IC 6-1.1-12-.07
F I resident address ot applicant Address of authorized person
15 �o 0
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