HomeMy WebLinkAboutMortgage_Moore (5)`° ry" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' :� FOR DEDUCTION FROM ASSESSED VALUATION
S � State Form 43709 (Rb l 70.07)
� Presaibetl Dy Department of Local Govemmeni Finance
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lNSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county wheie the property is /ocated. eVu
Filing Dafes: 1) Real Property: Dunng the 12 months before May 11 0/ the yea� the deduction is to be ef�BCtfJe2 6 Z�OZ
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 0( t year the deducUon is to be eflective.
See reverse srde /or additional instructions and qualifications. J/.'/, D
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Applicant (owner or contract buyer - see 2strictio on iev e side
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Taxing nd ey number / legal descripti n Record number �
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of is the applicant ihe sole tegal or equitable
March 1, current year Mar 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 than spouse, indicate with whom.
If name on record is different than that of appticant, indicate below: Is the property in question:
❑ Real Pmperty ❑ Mobile Home QC 61.1-�
�me of moRgagee or contraG seiler
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Address of mortgagee or contraIX seller (number and street, city, tate, ZIP
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Name of assignee or other owner or holder of mortgage
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Address of assignee (num6er and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
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20 ' 20 20 0 20 0� 20 O�! _ 20 � 20 O P �
5 �'�l40� � � 1� /� P
Sign ture County Auditor Date
I/ We certify under the penalry of perjury that the above and foregoing information is true and corred and that the applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
�� Si ure (ow s/ull name) ' Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
ull y dent add o ap icanl Address ot authorized person
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