HomeMy WebLinkAboutMortgage_Memmer (3)i;�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' � FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
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! �te Form 43709 (R615-0G1 " . . . •
� Prescribed by Depanment af Loral Govemmeni Finance
INSTRUCTIONS: � � �� i e ark
To be filed in person or by mail with the County Auditor of the county whe�e the p�opertv � a d.
Filing Dates: 7) Real Property: During the 12 months before June Il of the year the ded n i
2) Mobi/e Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of fhe yea� the deduction is to be effective.
See reverse side fo� additional insWctlons and quali(ications. � U � 1 � Z���
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Applicant (ownerorcont buyer- see rest�ctions on rev se side) IBSON COUNTY AUDITOR
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Taxing' Distrid Key number / legal description Record number Q f�
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a g73 number � ��
Assessed value of real operty as of Mortgage / Contract indebtedness unpaid as of Is the applicant ihe sole legal or equitable
March 1, curtent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other lhan spouse, indicate wilh whom. '
If name on record is different lhan that of applicant, indicate below: Is lhe property in question:
❑ Real Properfy ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contract seller ^
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Address of mortgagee or conlract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
1 —
Address of assignee (num6erand sfre , DPa,ye1' 1 _
Does applicant own property in any o' (;'��,�I ,\ O '�• • � Has this dedudion been requested on
couny in Indiana? � NQ_ 59/ � �� property for wrrent year? O Yes❑ No
, CD
�3�/9.45�'••.
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Dedudion approved in the amount of:
20 D� 20 20 20 20 20 20
/ �
SignaWre County Auditor Date
�/ We certify under lhe penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Sig re (owne/s lull name) Person authorized by duly executed Power of Attomey
, or by IC 6-1.1-12-.07
esident address of appli � Address of authorized person
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