HomeMy WebLinkAboutMortgage_Barrett�� R� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
'i• = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
'� �. J Stata Form 43709 (R6 / 5-06)
� Presai6ed by Department of Laal Gwemment Finance
INSTRUCTIONS: - ��� ,..1'
To be filed in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 7J Real Property: Dunng the 12 months before ,lune 17 0/ the year lhe deduction is to be eRective. �:
2) Mobile Homes assessed unde� lC 6-1.1 J: Between January 15 and March 2 of fhe year the deducUon �,tqbe eBective.
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See reverse srde for additional instructions and qualifications. 9 t;j(/)
Applicant
Taxing
buyer
—i�a ,�z -
Assessed value ofrealproperty as of
March 1, cutreM year
If no, what is his / her exact share of interest?
If name on record is d'rfferent than that
of mortgagee or
on reverse
/ legal descriplion � Record number
) • ^,� Pagenumber ���
LI�
MoRgage / Contrad indebtedness unpaid as of Is ihe applicant the sole legal or equilable
March 1, current year owneR ❑ Yes ❑ No '
If owned with someone other than spouse, indicate with whom.
Address ot moRgagee or conVad seller (number
assignee or other owner or holde
ot assignee (number and street, c
Does applicant am property in any other P
counfy in Indiana?
approved in the amounl of:
20 �� I 20 �
Q �
Signature
indicate,below: Is lhe pr
❑ Real
���,
id st2et, city, state, ZlP
r.
Arawer, \O..`'.� ..... .........
Card�rc..� �..'��a..:.�....
�� �xd� �S�,cCfJ
COUNTY AUDITOR
20 20 20
County Auditor
❑ Mobile Horrie OC 61.1
Has this deduction been requested on
propeAy for current yeaf? 0 Yes 0 No
20
Date
20
We certify under the penaity of perjury that the above and foregoing information is true and correct and that the applicants was / were
esident o( Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
'ress of applipnt IAddress of authonzed person
� $?�BlN �