HomeMy WebLinkAboutMortgage_Merrill�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
's �� / State Form 43709 (RS / 4-03)
� Pmscnbed by Depanmem of Local Govemment Finance
INSTRUCTIONS: E� � File•Mark-�
To be filed in person or by mail with the County Auditor o! the county where fhe property is located"� ��{ ��—{ �'. �
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0/ the year the deduction is-t'o 6e eflecliveA 1S,_/ �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year fhe deduction is to be effective.
See reverse side /or additional instructions and qualifrcations. � � � � 7 ZO��
� `1 � � n
Applicant (o� er ont ct buyer - see s'cti n everse side) /� �`� �/�?`�=�-'-Y�-c J�
G1OSGN CGUhTY ,^�UDtiC.; �
Taxing Disi �d Key nu ber / legal description Record number .. ��
%� D�� _O� y�� rOD Pagenumber ���
O
Assessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, cyr�nt year ownef? ❑ Yes ❑ No
T �
Ii no, what is his / her exad share of interest? If owned with someone other than'spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�e of mortgagee or contracl seller
% �CC�'� �%�G �z� �
Address of mortgagee or wntract selier (number and st�eet, city, state, ZIP
Name of assignee or otner owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current yea(? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � G 20 � 20 Q� 20 � 20 20 20
P i° P
Signature County Auditor Date
� We certify under the penalry of perjury that the above and foregoing information is true and corred and ihat the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
ign j re�( fs ame) ' Person authorized by duty executed Power of Attomey
� or by IC 6-7.1-72-.07
�. -
ulI resi t address of applica Address of authorized person -
aa��