HomeMy WebLinkAboutMortgage_Pickens� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. / State Fortn 43709 (R5 / 4-03)
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� PrespiDed Oy Department of Lotal Govemment Finance �—� �;! � �
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INSTRUCTIONS: File�''}
To be filed in person or by mail with the CountyAuditor of the county where the property is located. MaR U �`�4
Filing Dates: 1) Real PropeRy: During fhe 12 months 6efore May 17 0/ (he year the deduction is to 6e,eJiective. /l
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the 7�ear the deduction�/ to 6e/eHecNve.
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See reverse side for additional instructions and qualifications. ! �;ogp� �;OUwTY FuU""
Applicant (owneror contrdct - see restnction ievgr ) C���
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Tauing Distrid Key number / legal d scripli Record number O, `
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� Q� _ O� t/� 7 f,x Page number
r w I 3 �(3.
Assessed value of real property s of MoRgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? Ii owned with someone olher than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below: Is the property in queslion:
� Reai Property ❑ Mobile Home (IC G1.1-�
�me of mortgagee or contrad seller
Address of mortgagee or contracl seller number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appliwnt own property in any olher If yes, what county? What Taxing District? Has this deduction been requested on
counly in Indiana? property for current year? ❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 � 20 �� 20 � 20 �_ 20 20
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Signature County Auddor Date
�! We certify under the penalty of perjury thal the above and foregoing infortnation is true and corred and that ihe applicants was / were
resident of Indiana and owner of th aforementioned property on March 1, 20
Si na re owners /ull name " Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
ull r� ess a plipnt � A ress of authorized person