HomeMy WebLinkAboutMortgage_Harper (3)R no
�
�. `' :�. �
-�
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (R4l 70-01)
Prescribed by Department of Local Govemment Finance
FEB 19� 2002
INSTRUCTIONS: File rk .
To be (led in person or by mail with the County Auditor ol the county where the property is oc�ON COU. i v! UDITOR
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 oJ the year the deduction is to 6e eKecfive.
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year the deducfion is to 6e eHective.
See reverse side /or additional instnictions and qualifications_
Applica (owner or contracf buyer- see sfnctions on reverse side)
Taxing Distri ey number / legal desc tion Recor number
P - Page number
-U
Assessed value of real property as of MoAgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, wrtent year March 1, wrrent year �L\ ��Fl �T� owne(? ❑ Yes ❑ No
U
�
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 the property in question:
❑ Real Property ❑ Mobile Horr�e pC 61.1-�
��e of mortgagee or contracl seller_
(\
\.
Address of mortgagee or contract selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for curtent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amouni of:
�.
20 20 QY_ 20 ii 5 20 �� 20 �� 20
� P tiP
Signature County Auditor �� ,, � Date
F
�pP
�Ve certify under the penalty of pe�jury that the above and foregoing informati is true "�eat and that the applicants was l were
�ident of Indiana and owner of the aforementioned property on March 1, 20 �N GO
Signature (owners (ull name) Person a onzed by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full resident address of applicani Address of autho�zed person