HomeMy WebLinkAboutMortgage_Mizeur (2)rt�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' s FOR DEDUCTION FROM ASSESSED VALUATION
S � j State Fortn 43709 (R4 ! 16-01)
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PresaibeC by DepaNnent of Local Govemment Finance
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INSTRUCTIONS:
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To be filed in person or 6y mail with the County Auditor o/ the county whe�e the property is located. AP R �'
Filing Dates: 1) Real Property: During the 12 months belore May 17 0l the year the deduction is to be eflective. /!
2) Mobile Homes assessed under IC 6-1.1J: Between January 15 and March 31 of t year the d du n is to ne ffective.
See reverse side /or additional instructions and qualifications. G�ggON COLP7T Y AUDITOR
Applicant (owne o ontract buyer- see rictions on reverse side) •
Taxing District Key number / legal descrip n Record number
�O�-Obbg6�Ry� Pagenumber ^ O
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole I gal or equitable
March 1, curcenf year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the roperty in question:
Real Property ❑ Mobile Home QC 61.1-�
�me of mortgagee or contract seller �'�
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and s6eet, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty? What Taxing District? Has this dedudion been requesled on
county in Indiana? property for curtent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Sign ture Counry Auditor Dale
I/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
(o ners (ull na ) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
F II i t ad e of applicanl Address of authorized person °
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