HomeMy WebLinkAboutMortgage_Harvey (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
` / State Form 43709 (R3 / 70-00)
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PresaibeE by State Board ol Taz Commiuioners
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Instructionsforfiling:
To be filed in person or by mail with the County Audftor of the county where the property is
located during the 12 mortths before May 11 of the year the deduciion is to be effective. See
reverse side for additional insWdions and qualifications.
FORM 5
NOV 0 2 2001
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Applicant (9 r or contract buyer - see re ctions n reverse side)
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Taxing is G Key number / legal descnption Record number �� /
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/�"�, � � — � � — OO Page number . � 7 � / .
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year • March 1, current year , owner? ❑ Yes ❑ No
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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 ihat of applicant, indicate below:
� of mortgagee or contract seller
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Address of moRgagee or conVad seller (number and street, city, state, IP _
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Name of assignee or other owner or holder of mortgage
Address of assignee (number and sUeet, aty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing District? Has this dedudion been requested on
other county in Indiana? property for current year? � Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
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20 ��.1` " Zo zo o� zo 0.3 zo o t� so `_ zo o B' 09
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Signa re County Auditor Date
�I/ e certify under lhe penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Sign ture (owners lull name) Person authorized by duly executed Power of Ariomey
I �� �.`� or by IC 6-1.1-12-.07
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II resident address of applip�jt Address of author¢ed person
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