HomeMy WebLinkAboutMortgage_Meuser (2){4 R�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' = FOR DEDUCTION FROM ASSESSED VALUATION
� �J State Form 43709 (R4 / 10.01)
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Prewibe0 by DepaMeN of Local Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail wifh the County Auditor of the county where the property is located.
Filing Dates: 1) Real P�operty: During lhe 12 months be%re May 11 0l the year the deduction is o
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 t
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De effective. 20�2
e yeaC the tleducfion is to be e8ective.
See reverse side !or additional insGuctions and qualifrcations. GiggON
buyer-see
Taxing Distrid
on reverse side)
Key number / legal description � Record number
b
t/JL��( C//CQ.� OQ — � a a� — C� Page number
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Assessed value of real property as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, curtent year March 1, curtent year owner? ❑ Yes ❑ No
3-�/aoo
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
name on rewrd is different than that of applicant, indicate below:
of mortgagee or contract seller
Address ot mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20
Signature
20
� ' : � � �
What Taxing District?
COUNTY AUDITOR
20 af�_ 20
�
County Auditor
❑ Real Properiy � Mobile Home (IC 61.1
�
Has this deduction been requested on
property for wrrent year? �] Yes ❑ No
20 �
Date
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We certify under the penaity of perjury that the above and foregoing information is true and correcl and that the applicants was ! were
resident of Indiana and owner of the aforementioned property on March 1, 20
ture ( wner' full name) Person authorized by duly executed Power of Attorney
� �'��'„�, rf��_ .� „ . orbylC6-1.1-12-.07
ident address of applicant Address of authorized person
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