HomeMy WebLinkAboutMortgage_Walton`°R� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
4 State Form 43709 (Ra / 70.01) � -
�IN� � •
Prescribe0 by DeDartmen� W Lxal Govemmenl Finance
INSTRUCTIONS: ��' E, File Marli
To 6e filed in person or by mail wifh the CountyAuditorol the county where the properiy is located �� `� ��� ,y
Filing Dates: 1) Real PropeRy: D�ring the 12 months 6elore May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC &1.1-7: 8efween January 15 and March 31 of the year the deduction is to be eHective.
r��u i � r.,,J.,
See reverse side for additional instrucfions and qualifications.
^
nt (owner or contract buyer- see
ri d W, zr.E� 1, i�d
Dislrid
� I I C�� eka. �.v�
Assessed value of real property as of
March 1,curtenlyear
I( no, what is his / her exacl share
If name on record is different than thal
morlgagee or conirad seiler
on reverse side)
�... :).) a�..l,'�dv��
Key number / legal description
i'oo�- ooy�4l-ao
- � 9..�.n
�rd number
)3—%�'"1 S
� number �
Mortgage / ConlraU indebtedness unpaid as of Is the applicant, �thy sole legal or equitabb
March t, curtent year ownefl �dYes ❑ No
' � 69, �oo.00 �
Ii owned with someone other than spouse, indicate with whom.
indicale below:
a
Address of mortgagee or contrad seller (number and street, ciry, state, ar
Name oi assignee or olher owner or holder of mortgage
Address of asslgnee
Does applicant own property in any
counry in Indiana?
approved in the amount of:
r�. � �
, , ,, �
.��
state, ZIP code)
whal county7 � What Taxing District?
COUNTY AUDITOR
20 Ul� 201
� �
Counry Auditor
20��
sthe propertyin quesuon:
❑ Real Pmperty ❑ Mobile Home QC 61.1 :
�, 6`�-3�3�
�, o P - �yr�
Has this dedudion been requested on
propeAy for wrtent year? � YesO Nc
20 �� 20
P
Date
I/ We certi(y under the penalty of perjury. that the above and foregoing infortnation is true and corced and that the applicants was / were
a resident of Indiana and owner of lhe atorementioned property on March 1, 20
Signature (owners full name) Person authorized by duly exewted Power of Attomey .
i�t . n i. .�. �_ o-r— _ or by IC 6-1.1-12-.07
i resideni address of applicant
.{Z . 3,�oq, I'(S A, P�t nce�ar., I►'
of authorized person