HomeMy WebLinkAboutMortgage_Scherbrt�O STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S J Siate Fofm 43709 (R4 / 10.01)
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Prescribe0 by Department ol Local Govemment Finance
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INSTRUCTIONS: i1011Q�y File Mark
To 6e (led in person or by mail with the County Auditor of the county whe2 the praperty is Ioc A 1 �O� N�O,�S,�81�Jp�
Filing Dates: 1) Real Property: During the 12 months betore May 11 o/the year the deductio s t e elfe v���"�� ✓
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the year pe d duction is t e ef/ective.
See reverse side lor addifional inst�uctions and oualifications_ 7nn� e_ .
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Applicant (o r r co tract buyer see rest ctions on reverse si�e)
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Ta�cing Dist' Key number/ legal ption Record number �.
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Assessed value of real property as of Mortgage / ContraIX indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
I( 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 applicant, indicate below: Is the property in question:
Real Property ❑ Mobile Home (IC 61.1-�
Name of moRgagee or contrad seller
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Address ot mortgagee or conlrad seller (number and st�eet, city, state, ZIP
Name of assignee or other owner or holde mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Tauing Distrid? Has this dedudion been requested on
county in Indiana? property for current yea(? � Yes � No
COUNTY AUDITOR
Deduction approved in the amounl of:
4
,0
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Signal re County Audilor Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicanls was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
ignatu e(owners full na Person authorized by duly execuled Power of Attomey
� : � ��_ or by IC 6-1.1-12-.07
Full re�ident address f applipnt Address of aulhorized person
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