HomeMy WebLinkAboutMortgage_Sisson� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' � FOR DEOUCTION FROM ASSESSED VALUATION
S J Siate Fortn 43709 (R4 / 10-01)
��� Prescribe0 by Depanmenl W Lotal Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ the county where the property is located. ��II'�,I 1$ 2�03
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ the year the deduction is to be et�l�.
2J Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the-year the deduction is to be eHective.
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See ieverse side for additional inshuctions and qualifica6ons.
n (�BSO(��' U'IYhV�?ITC1R
Assessed value of real property'as of
March 1, current year
If no, what is his / her exact
on rev¢r$e side)
Key number / legal description Record number O�
fYY , ��fi�J �� Page number �� /�
lj.C.,(O / /
Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtenl year owneR ❑ Yes ❑ No
If name an record is difierent lhan ihat of applicant, indicate below:
of mortgagee or conVact seller
Address of mortgagee or contract seller (number
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
If owned with someone other lhan spouse, indicate with whom.
ZIP
Is lhe property in question:
❑ Real Property ❑ Mobile Hane (IC 61.1-�
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Does applipnt own property in any other If yes, what county? What Tauing DistriC
county in Indiana?
COUNTY AUDITOR
approved in the amount of:
�'i )V �
��
�_ 20�(� 20Q
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County Auditor
Drawer N0.4!.��• ��•r� •
i
CardNO . .................... o
20� 20� 20
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Date
/ We certify under the penalty of perjury that the above and foregoing infortnalion is true and correc[ and lhal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly
or by IC 6-1.1-12-.07
person
Power of Attomey