HomeMy WebLinkAboutMortgage_Comer;��°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' � FOR DEDUCTION FROM ASSESSED VALUATION ��j" o 7ownship Year
— �e �',•. � State Fortn 43709 (R6 / 5-06) � p �
Prescobed by Depanmen� ol Locai Govemment Finance g'
i JUN 0 [
INSTRUCTIONS: File Mark
To be liled in person o� by mail with fhe County Auditor o/ lhe county where the propertv�isJlocated:�,
Filing Dates: 1) Real Property: During the 72 monihs before �une 11 of fhe year the deduct on7s to be eltective.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 apti:�fch;2riiF'ffii� }�64ji'ePdeduction is to be e!/ective.
See reverse side lor additional instructions and quali�cations.
or m�aracr nuver - see
Taxing Distrid
Assessed value of real property as of
March 1, curtent year
what is his / her exact share of interest?
If name on record is different than
�me of mortgagee o contrad seller
Address of mortgagee or contrad sel
on reverse side)
Key number / legal desuiption
Mortgage / Contrad ir
March 1, currenl year
il, indicate below:
and eet, Gty, s,
Name of assignee or other owner or holder of mortgage
st�eet, city, state, ZIP code)
as
Record number 1'
' �7
Paae number n.-. _
is me appucanc cne soie iegai or
ownef? ❑ Yes ❑ No
If owned with someone olher lhan spouse, indicate with whom.
Does applicant own property in any other If yes, what county? What Taxing District?
county in Indiana?
Dedudion approved in the amount of: D �:1 tiYG' �'Q���' 7P�s
20 � 20 20 C:lt-� !\�S-�ty���,�_ .
Q �
Signature
❑ Real PropeM ❑ Mobile Home OC 61.
Has this dedudion been requested on
property for wrrent year? � Yes � No
20
Date
�
' We certify under the penafty of perjury lhat the above and foregoing infortnation is true and correct and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
3nat re s(ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
il r ident address of applicanl Address of authorized person
/�O % /1J. �$G�K-T�G