HomeMy WebLinkAboutMortgage_Weber (9)_ i C?`i� .
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn 43709 (R3 / 7690)
PreSCribeA by S�ate Boartl ol Tex Commissioners
Instructions for filing: �
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be eBective. See ,
reverse side for additional insWCtions and qualfiptions.
FORM 5
Coun Township Year
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JUN �� �M�1
��B/��ry AUQITOR
Applicant (own r rcontract buyer- see stnctions o reve e side) . .
Taxing Distrid Key number / legal description Record number
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6 I�^� O Page number �
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Assessed value of real property as f Mortgage / Contrad indebtedness unpaid as of Is the appliqnl the sol legal or equRable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate wfth whom.
If name on record is different than that of applicant, indicate below:
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� of mortgagee or contrad seller
Address of mortgagee or contred seller (numb nd sbeet, city, state, ZIP - ,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code) '
Does applicant own real property in any If yes, what county? What Taxing Distrid? Has this dedudion been requested on
other county in Indiana? property for current yeaf? 0 Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Sign re County Aud'Ror Date
��-We certiy under the penally of peryury that the abave and foregoing infortnation is true and corted and that the applicants was / were
ident of Indiana and owner of ihe aforemenlioned property on March 1, 20
Si aTure (owners ful ame) n Person authorized by duly exearted Power of Attomey
� or by IC 61.1-12-.07
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F resident address of applipnt � Address of author¢ed perso�
R a� eo- x- i y 9 0�
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