HomeMy WebLinkAboutMortgage_JenksSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES;
FOR DEDUCTION FROM ASSESSED VALUATION
\ , State Fam 43709 (R3 / 10-00) .
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�r� PreSCribeA by State BoarO ot Ta: Comrttissioners
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Instrvctions for filing:
To be filed in person or by mail with the County Audftor of the county where the property is
located during the 12 months before May 11 oi the year ihe dedudion is to be effedive. See
reverse side far additional insWCtions and qualfica5ons.
or contract buyer - see
:tions on reverse side)
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Key number / legal description
f�!'1 �.. �' i�lt�4 `-� , —
Assessed value oi real property as of Mortgage / Contrad ir
March 1, curtent year � March 1, current year
If no, what is his / her exact share of interest?
If name on recard is different than that of applicant, indicate below:
of mort9a9ee or contrad seller
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1
Fi rk
SEP 2 0 2001
'° GIBSON
Record number
` Page number
J
as of Is the appli�
owneR
FORM 5
Year
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� ihe sol legal or equRable
❑ Yes ❑ No '
If owned with someone other than spouse, indiqte with whom.
of moRgagee or contrad seller (number and street, ciry, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, aty, state, ZIP code)
Does applicant own real property in any If yes, what counry? I What Taxing Distrid?
other county in Indiana?
Dedudion approved in the amount
20�'� I 20�
COUNTY AUDITOR
Caunty Auditor
20 Q(�
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Has this dedudion been requested on
property for current yeaR ❑ Yes ❑ No
20
Date
20
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certify under the penalty of perjury that lhe above and foregoing information is We and coned and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
e wne full na�`� V�� —_ Person authorized by duly exearted Power of Attomey
or by IC 61.1-12-.07
ident a ress of appli t Addreu of authorrzed person
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