HomeMy WebLinkAboutMortgage_Archer�e�'� 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i'� FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�!+ State Fortn 43709 (R6 / 546) �
� Presoibed by Departmem of Local Govemment Finance ��
DEC 0 6 Z006
INSTRUCTIONS: File Maric
To be filed in person or by mail with the CountyAuditor of the county where the property is located. �-y�
Filing Dates: 1) Real P�operty: Dunng the 12 months 6efoie ,lune Il of fhe year the deduction is to 66'E� �
2J Mobile Homes assessed under IC 6-1_ 1-7: Between January 15 and March 2 o��rLt��u �p��p be eflective.
See reverse side for additional instnictions and qualifications.
Appli t er or contract bu r- see 2strictio n reverse side)
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Tauing Dislrid Key number / legal descri tion Record number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, curtent year owneR ❑ Yes ❑ No
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If no, what is his / her exact share ot interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hmie pC 61.1-�
�ame of mortgagee or contrad seller
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Address of mortgagee or conVact seller (number nd street, city, state, ZIP
Name of assignee or other owner or holder of moRgage
Address of assignee (num6er and st2et, city, state, ZIP code) -
Does appiicant own propei , iing Dislrict? Has this deduqion been requested on
county in Indiana? Q�. `. ��! � property for current year?❑ YesO No
Drawer NO......
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Card NO . ..................... rt
Dedudion approved in lhe /
20 �� 20 C'�Sr 20 �9_ 20 20 20 20
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Signalure County Auditor Date
��1 / We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
a resideni of Indiana and owner of the aforementioned property on March 1, 20
� Signature (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
� Full resident address of applicani Address of authorized person