HomeMy WebLinkAboutMortgage_Barnett�ei �A� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'+'�; FOR DEDUCTION FROM ASSESSED VALUATION o n s Year
�'� • Sute Form 43709 (R6 / 5-06)
��• Presrn6ed by Department of �ocal Govemment Finaixe
INSTRUCTIONS: �.., Fil�,t�Qaric
To be filed in pe�son or by mail with the County Audiror of the county whe�e the property is located.
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Filing Dates: f) Real P�operty: During the 12 months before ,lune 17 of the year lhe deduction is to U
�1��1"@OUNTY AUDITOR
2) Mobile Homes assessed under IC 6-1. 7-7: Between January 15 and March 2 of the year the deducG'on is to be elfective.
See �everse side for additional instnictions and quali�cations.
Ap icant (owner or contract buyer - see resMdions on reverse e)
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ing Dislrict Key number / legal description Record number
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y(�, �!)� _ _ _ _ _ Page 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 equitabie
March 1, curcent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of inlerest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobite Home QC 61.1-�
e of mortgagee or trad seller .
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Address of moRgagee or conVaIX seller (number and street, city, state, ZIP
Name of assignee or olher owner or holder of mortgage � 4i�,� � 2� G'�
Address of assignee (numberand street, city, state, ZIP code) 1��`
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Dces applipnt own property in any other If yes, what county? What 7 U X-/=�5�% quested on
county in Indiana? � ] YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20�� 20�0 _ 20 20 20 20 20
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Signature County Auditor � Date
�We ceAify under ihe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
asident of Indiana and owner of the aforemenlioned property on March 7, 20
, Sign ure (owne 11 e) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full res t addres of applicant Address of authorized person
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