HomeMy WebLinkAboutMortgage_Haas (2)�Pa�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Cou wns "'I ar
� �� ! State Fwm 43709 (RS / 4-03) �
�M• . _
PrescnDed by Departmem of Local Govemment Finance O� r�
INSTRUCTIONS: Fil �
To 6e filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May i1 of the year the deduciion is to be eH�L�N C U Y AUDITOR
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and Maich 2 0! the year the deduction is to be eNective.
See reverse side for additional instructions and qualifications.
Applicant (owneror�ontra t buyer- see restrictipns o everse ide)
v G��
Taxir�,pislrid Key number / legal description Rewrd number �
1 / «�\,0�� �� �- 6
C �J O x/_ —(� Page number //
� �� �o �. f
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, wrrent year ownef? ❑ Yes ❑ No
� 1�laoo.
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 differeni than that of applicanf, indicate below: Is the property in question:
�. ❑ Real Property ❑ Mobile Home (IC Cr1.1-�
'�ie of mortgagee or contract seiler
\ Address of mortgagee or contraq seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, city, sfate, ZlPcode)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year?Q Yes❑ No
UNTY AUDITOR L, � � ���
Deduction approved in the amounl of:
20 i 20 Q2 20 O� 20 �� 20 20 20
P P P
Signature County Auditor Date
�Ne certify under the penalty of peryury that the above and foregoing informalion is true and corred and that the applicants was / were
_ resident of Indiana and owner of the aforementioned property on March 1, 20
Signature owners (ull name) Person authorized by duly executed Power ot Atlomey
S or by IC 6-1.1-12--07 '-- �
Full r ident address of applipnt Address of authorized person
�i� y ,�xa�ry �'nce-�� y7�