HomeMy WebLinkAboutMortgage_Whitehead (2)rt�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �
' FOR DEDUCTION FROM ASSESSED VALUATION C u T s' Year
•� --�� �,/ Sute Form 43709 (R5I4-03) .
� Ptesaibed Dy Deparvrcent ol Local Governmem Finance q � 0 3 2005 �
INSTRUCTIONS: ���ryt�iG",l �
To be filed in person or by mail with the CountyAuditor of the county where the property is located. ��g gqN COUNTY UOITOR
Filing Dates: 1) Real Property: During the 72 montbs 6elore May 11 0/ fhe year the deduction is to be elfectroe. .
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 olthe year tAe deduction is to be effective.
See reverse side for additional inshuctions and qualifications.
Applicant (owner or contract buyer- see restrictions on reverse side)
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Taxing Disfnd ey number! legal desuiption Record numberO �- �„ G
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Page number
OU b-0358�- �
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, currenl year March 1, wrrent year ownef? ,� Yes ❑ No
I S�
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 differeni than lhat of applicant, indicate below: Is the property in question:
eal Pmperty ❑ Mohile Hmie pC 61.7-�
�3me of mortgagee or coNract seller • _�
Address of mortgagee or contrad seller (number st2et, city, state, ZIP
� Plame of assignee or other owner or holder of mortgage S Z��--� �
IAddress of assignee (num6er and st2et, city, state, ZIP code) Dra�veC �r�....°. 44^! .......
Does applicant own property in any olher If yes, what county? What Taxing C Card N�. ..... �7.�v ,,,,, , o��
coimty in Indiane? k} I��� � �No
x
� c',a � COUNTY AUDITOR � L
�/
Deduction approved•in t e'amount of: .
,
20 ' 20 � 20 � 20 20 20 20
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Signature Counry Auditor Date
I
�/ We certify under the penalty of perjury thal the above and toregoing information is true and correct and ihat lhe applicants was / were �
a resident of Indiana and owner of the aforementioned property on March 1, 20
Sig re ow rs lull name) Person authorized by duly exewted Power of Atlomey - -�
,h ., or by IC 6-1.1-12-.07
ulI resideh(`� dress of applicant Address of authorized person
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