HomeMy WebLinkAboutMortgage_Huffman� STATEMENT OF MORTGAGE OR CONTRACT INDEBTE
FOR DEDUCTION FROM ASSESSED VALUATION �� Co ownship Year
�•. �� / State Form 43709 (RS ! a-03) � �
� Prescribed by Departmam ol Loral Govemment Financa n 0 9�oo
Mn
INSTRUCTIONS: ��� �Q� File Mark
To be filed in person or by mail wrth the County Auditor of the county where the property is loc te . DITOR
Filing Dates: 1J Real Property: Dunng the 12 months before May 11 of the year the ded�(g�Q6Jt6�@��c!°l�.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year the deduction is to be effective.
See reverse side lor additional instrucfions and quali�cations.
Applicant (owner
Taxing Distrid
./ /J 1�;
see resmcn s on revf
I
Key number
.i : � ,.
number
� � ` •' Page number
�o.3k,�� � �� IR�� .
Assessed value of real property as of Mortgage / Contrad indebtedngss unpaid as of Is the applican the so e legal or equitable
March 1, current year March 1, wrrent year owner? ❑ Yes ❑ No
�7000 -• � �
If no, what is his / her exact share of inlerest? _ _If.owned with someone other lhan spouse, indicale with whom.
j�/o_ol
If name on record is different than th�
of mortgagee or contraIX selle
Address of mortgagee or contrad se
U ��id�'J°�
�(�'�7 n�
01
—�i�l iA
�{�.--ad--�
b
V
assignee or other owner or holder oi mortgage
of assignee (number and sf2et, city, state, Z1P code)
Does applicant own property in any other I if yes, what wunty? What Taxing Distrid?
county in Indiana?
20
Signature
approved in the amounf of:
20 �j �'
COUNTY AUDITOR
20 � 20 20
P
County Auditor
❑ Mobile Home (IC 61.1
�
Has this deduclion been requested on
property for current yea(? 0 Yes ❑ No
20
Date
20
We certify under the penalty of perjury that the above and foregoing information 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 of Attorney
or by IC 6-1.1-12-.07
Full residenf address of applicant �Address of authorized person