HomeMy WebLinkAboutMortgage_Brown (13)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VA�UATION 7o n ip Year
:. p� / State Form 43709 (R5/ a-03) �
� Presrnbed by Departmenl of Loral Guvemment Finance
INSTRUCTIONS: � File !��
To be filed in person or 6y mail with the County Auditor ol the county where the property is located. a� �
Filing Dates: 1) Real PropeRy: During fhe 12 mon[hs 6efore May 11 0) the year the deduction is to b���QUNTY AUDI70�
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to 6e e ective.
See reverse side for additional instructions and qualifrcations.
Applicant ( ne� or contract buyer- ee restrictions on reverse side)
Taxing Distrid Key number / legal description Record number
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` ^ .1 ^ f� Page number � Q ��
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Assessed value of real properly as of Mortgage / Conirad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, current year ownef? �es ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of appliwnt, indicate below: I the property in question:
� �teal Property ❑ Mobile Home QC 61.1-�
" me of mortgagee or contract seller
Address of mortgagee or QNrect seiler (number and 5t2et, city, st ' - __
Drawer NO.,,�,�,� :.�G �,,
Name of assignee or other owner or holder of mortgage . �
Address of assignee (numberand street, city, state, ZIP code) Card ND . �....
Does applicant own property in any other If yes, what wunty? What Taxing v�n.�.,,.. ion been requested on
county in Indiana? prope��y ,_. . rent year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
2o a r� 2o zo � 20 0� zo zo zo
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Signature County Auditor Date
'/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that lhe applicants was / were
esidenl of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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