HomeMy WebLinkAboutMortgage_McEllhiney (6)��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
/ S�ete Fwm 43709 (R6 / 5-06)
�Resaibed by Departmenl of Laal Gwemment Finance
7
INSTRUC710NS:
� �
File� �
Year
To be filed in person or by mail wdh the County Audito� of the county where the property is located. �
Filing Dates: 1) Real Property: During the 12 months 6efore �une 11 oi the year the deduction is to be effective.
2) Mo6ile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0l the year th���lu�ic(� I��te�e elfective.
See reverse side (oi additional instnictions and quali/ications.
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Ap nt (o ner trac ee 2stnctio on mve�ri side) -�'�"" �OUNTy q�DITpR
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Ta g Dis 'ct Key number / legal description Record number O -� O
� � - Page number
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Assessed value of real property as of MoRgage I Contract indebtedne s unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? Q Yes � No
If no, what is his / her exact share oi interest? If owned with omeone oiher than spouse, indicate with whom.
If name on record is different th n at oi applicant, indicate below: Is [he property in question:
�r On�Ho�pc��.i-�
N�me of mortgagee r contract s r '/
� a��r�� QO QOy:33 3 —0��
Address of mortgagee or contract seller (number and streef, city, state, Z/P /
/�
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any oUier Ii yes, what couniy? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year? ❑ YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 Q 20 6 20 �_ 20 20 20 20
P
Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is W e and correct and that the applicants was / were
sident oi Indiana and owner of the aforementioned property on March 1, 20
, t re (owners full name� • Person authorized by duly executed Power of Attomey
`-1 C or by IC 6-1.1-12-.07
�up resi ie3t a re,�s � a �� t n�� C e `� Address of authorized person •
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