HomeMy WebLinkAboutMortgage_Oneali q 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1\s-'�'; FOR DEDUCTION FROM,ASSESSED VALUATION �o Year
\�!• State Form 43709 (R61 S-06) � ' '
�I Presaibed by Department of Loml Gwemment Fina�e
INSTRUCTIONS: File Maric
To be filed in person or by mail with fhe CountyAuditor of the county where the p�operty, is locafed. °� ',"{��
Filing Dates: � Real P�operty: Dunng the 12 months before June 11 0/ the year the deduction is to be e��v�N CA � A�� ���
2 Mobile Homes assessed under lC 6-i.1-7: Between January 15 and �March 2 0( the year the educ6on�is to Db� ive.
See reverse side for additional instructions and qualifrcations.
se% iestrictio�s on
�/ f Ln
� ��ey num�er /
side)
number
OI �v ' Page number
Assessed value of real property as of . Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, curtent year �� ownef? � � Yes ❑�No � � �
i
Ii no, what is his / her exad share of interest? �i If owned with someone other than spouse, indicate with whom.
name on record is difterent than that
Name
of mortgagee or contrad
indicate
of mortgagee ar conVad seller (number and
or other owner or holder of mortgage
of assignee (number and street,
Cliy,
code)
Does applipnt own property in any other If yes, what wunry?
county in Indiana?
20
Signature
approved in the amount of:
20
❑ Real
❑ Mobile Home QC 61.1-�
ZIP ' . /�'.i � �.. m A"�/ %��/'� �
U
pvuw�o ✓ _ —
O� _ g' � -
What Taxing Dis,..,.,. �n
Iproperty for wrtent yeaR 0 Yes � No
COUNTY AUDITOR
20 20 20
County Auditor
20
Date
20
certify under lhe penalty of peryury thal lhe above and foregoing information is irue and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ire (owner full name Person authorized by duty executed Power of Attomey
p � D� �_�� or by IC 6-1.1-12-.07
I�Fal reside address of applipnt Address of authonzed person
%� , �,�L `> `�/