HomeMy WebLinkAboutMortgage_GruttadaurioSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� SUte Form 43709 (R4 / 10-Ot)
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� PresaibeE by Department of Local Govemment Finance '';j'-Z �
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�rusrRUCnoNS: APR 15 2���Ma�
To 6e filed in person or by mail with the County Auditor o/ the county wheie the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months be/ore May 11 of the year the deduc6on�is to be eHective.,� r
2) Mo6ile Homes assessed under IC 6-1.1-7: Belween January 15 and March 3�1iof the year the deduction'is to be eHective.
See reverse side lor additional inst�uctions and qua/ifica6ons. ,��Ig�J�� � 70R '
Applic�t�a�ynerorcon t buyer- re rictions on reverse si �
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Taxing Distrid Key nu er / legal description Record number O
� DO -c,�3a b Pagenumber
Assessed value oi real property as of MoAgage / Contrad indebtedness unpaid as of Is the applipnt the sole egal or equitable
March 1, curtent year March 1, current year ownef? �es ❑ No
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is difterent than that of appticant, indicate below: Is the property in question:
❑ Real Pmperiy � Mobile Horne pC 51.7-�
�ame of mortgagee or conlraIX selier ^
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Address ot moRgagee or conVacl seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Dces appliqnt own property in any other If yes, what county? What Taxing Disirid? Has this dedudion been requested on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 �� 20 Q_ 20 O� 20 �� 20 �l � 20 �
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Signature County Audilor Date
I/ We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corzed and that ihe applicants was / were
� resident of Indiana and awner of the aforementioned property on March 1, 20
Signature ners /ull name) Person authorized by duly executed Power of Attomey
' or by IC 6-1.1-12-.07
Full residen dress o applipnt Address of authorized person