HomeMy WebLinkAboutMortgage_Sherman�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
°. w� �/ State Fwm 43709 (RS I 4-03) `1
� PrescriDed by Department ot Local Govemment Finance ^`p�
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INSTRUCTIONS: --�File Maric -�
To be filed in person or by mail with the County Auditor o/ the county where the propeRy is located. �'-� �, �� t`-�
Filing Dates: 1) Real Property: During fhe 12 months before May 11 of the year the deduction is to be eflective. .� ��� 2�J
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the deduction is to 6e eflective.
See reverse side for additional instructions and qualilcations. � � T � I 2���
Applicanl (owner or
Assessed value of real property as
March 1, current year
io on refrJse side)
I—
Key num er / legal description F
� .� 333�, F
Mortgage / Contrad indebledness unpaid as of
Marchl,currentyear I10���0.�
a numoer Q
number �- ' `
l(
Is lhe applipnt the sole legal or
owneR ❑ Yes ❑ No
O O
If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
� Real Property ❑ Mobile Home (IC fr1.
��ne of mortgagee or contracl seller
Address of mortgagee or contred seller (number and street, city, state, Z
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6er and stieet, ciry, state, ZIP code)
Does applicant own property in any other If yes, what wunty? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current yea(� � Yes ❑ No
Deduction approved in the amount of:
20 � (r, 20
9�
Signature _
COUNTY AUDITOR
�_ 20 a�' 20 Q� I 20
P /'
County Auditor
20
Date
20
certify under the penalty of perjury that the above and foregoing information is true and corred and thal ihe applicants was / were
lent of Indiana and owner of lhe aforemenlioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
address of applicant Address of authorized person
:�. �6X 3c1� �