HomeMy WebLinkAboutMortgage_Shoulders (3)rt� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
-' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� Stale Form 43709 (R4 / iP97j
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Prexribed by Department W Lotal Govemment finance
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INSTRUCTIONS: � � File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. �V
Filing Dates: 1) Real Property: During fhe 12 months belore May 11 oJ the year the deduc6on is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the year tlqe,�duction ��e e8ective.
See reverse side (oradditional instructions and qualifica6ons. �,
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Applicant (owner r'co t b r see resMcUons v rs SidB) '.dSON CU� �� i Y .i •��i wn i
Tauing Distrid Key num er / legal description Recor mber �
����,�� � �� - D iA� 7- oa Page number �
Assessed value oi real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
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I( no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appticant, indicate below: Is the property in question:
❑ Real Pnoperty ❑ Mobile Home QC 61.1-�
' me of moRgagee or contrad seller
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Address of mortgagee or conirad selier (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 applipnt own property in any other if yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 0 5 20 �_ 20 20 � 20 �3_ 20
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Signature County AudRor Dale
�i/ We certify under the penalty of peryury that the above and foregoing infortnation is true and corred and thal lhe applicants was / were
, resident of Indiana and owner of the aforementioned propeRy on March 1, 20
gnature (A� full nam Person authorized by duly execuled Power of Attomey
� or by IC 6-1.1-12-.07
uli resident addr s of applipnt // _ Address of �uthorized person
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