HomeMy WebLinkAboutMortgage_Bacchi� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
` FOR DEDUCTION FROM ASSESSED VALUATION
�. � J State Fwm 43709 (RS / 4-03)
f Prescribed Cy Department of loral Govemment Finance
Coun Township Year
INSTRUCTIONS: File Mairk
To be Cled in person or by mail with the County Auditor of the county where the property is located. E,� �� r� � 2007
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 of the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 0/ the year the deductron is to be eHective.
See 2verse side (or additional instructions and qualifrcations. �(A� �b J 20�4
.
Applicant (owner or cq/itr�ct t�G�er - see
Taxing Distrid
0�� �
Assessed value ofrealproperty as of
March 1, wrrent year
If no, whaf is his / her exact share of
reverse side)
Key number / legal description Record number f) 2
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MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
3S��D
If wned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate
,me of mortgagee or contract seller �
C2 1�lri�G ��i f�(�.-tdi n q �-
Address of mortg e ntracl seller mber and street,
tJame of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own propef-��'�any other I If yes, what county?
counry in Indiana?
state, ZIP
What Taxing Distrtd?
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er
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Deductionapprovedi Ca�.d O,�¢�,�.�� ^ OR
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Signature _
County Auditor
s the property in question:
❑ Real Praperty ❑ Mobile Home QC 61.1-
Has this deduction been requested on
property for current year? � Yes ❑ No
zo
Date
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We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Attorney
or by IC 6-1.1-12.07
Address ofauthorizzd person
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