HomeMy WebLinkAboutMortgage_Dallmier (2)STATEMENT OF MORTGAGE OR CONTRACT INDI
: FOR DEDUCTION FROM ASSESSED VALUATION
S- � y Siate FOrtn 43709 (R4 / 10-01) ^_
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�� PresaibeA by Department of iocal G�vemmeni Finance \�
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� Coun Township Year
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor oJ the county whe2 fhe property is located.
Filing Dates: 1 J Real Property: During the 12 months belore May 11 0/ the year the deduction is fo 6e effective.
2) Mobile Homes assessed �nder IC 6-1.1-7: Between January 15 and March 31 oI the year the deduction is to be ef(ective.
See reverse side for additional instruc6ons and qualifica6ons.
(owner or contract buyer� see r�strictions on
Taxing trid / O Key number / legal description Record number t� �
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Assessed value of real properry as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year ownef? ❑ Yes ❑ No
(nY��� �.,� ��i�i
If no, what is his / her exact share of interest?
If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that ot applicant, indicate below:
'ame of mortgagee or contrad seller � 1
3
Address of mortgagee or contraIX seller (number and s reef, aty, state, ZIP
Name of assignee or otner owner or holder of mortgage
and st2et, city, state, ZIP code)
Does applipnt own property in any other I If yes, what county? I What Taxing Distrid?
county in Indiana?
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Signature
approved in the amount of:
20
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COUNTY AUDITOR
20 0 4 zo 0'1 zo �
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County Audftor
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property
❑ Mobile H«ne (IC St.
Has this dedudion been requested on
property for current yea(? � Yes ❑ No
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Date
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/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and lhat the applicants was / were
resident of Indiana and owner of the a/orementioned property on March 1, 20
gnat e ner (ull n e) Person authorized by duly executed Power of Attomey
��� ��� O or by IC 6-1.1-12-.07
resident ad�fess of applf�ant „ �Address oi authorized person