HomeMy WebLinkAboutMortgage_ODell�ee '� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'�i' �� FOR DEDUCTION FROM ASSESSED VALUATION o t T ns ' Year
«. > Slate Form 43709 (R6l 5-OG)
� Presaibed by Depanment of Loral Gwemrtrent Finance
INSTRUCTIONS: � � 5jle Mark
To be filed in person or by mail wrth the County Auditor of the county where the p�operty is located. ����'
Filing Dates: 1J Real Property: Dunng the 12 months before ,lune 17 of the year the deduction is t����f��Y AUDITOR
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 o/�t�re year the deduction is to be effective.
See reverse side fo� additional instruclions and qualifications.
Applicant (owner or ntract buyer - see restrictions on reverse side)
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Taxing Distrid Key number / /le�gal d scription Record number �
/ GF ( O'�L,� Page number / O�
a (o-1 ol -O (o - /o o -cx� /. - a
Assessed value of real property as of Mortgage / ontrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
a a �� d
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on recard is different than that of applicant, indicate below: Is the property in question:
eai Properly ❑ Mobile Home QC 61.1-�
me of mortgagee or conVact se le
Address of moRgagee or contract seller (number and st2et, city, state, Z P •
Name of assignee or other owner or holder of mortgage �` ��
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Address of assignee (numberand streef, city, state, ZIP code) D�•a �ti, , ��
�'' 1� 0..� CP
Dces applicant own property in any other If yes, what county? (,`� r� i\� �� :n requested on
county in Indiana? �• �� :ar?0 Yes❑ No
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t. �� J I 3aG COUNTY AUDITOR
Deduction approved in the amount of:
20 �� 20 �� 20 20 20 20 20
P P
Signature County Auditor Date
I We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
residenl of Indiana and owne f the aforementioned property on March 1, 20
$j�7nature w Person authorized by duly executed Power of Attomey
� V� , or by IC 6-1.1-12-.07
F�esident address of applicant Address of aulhorized person
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