HomeMy WebLinkAboutMortgage_Gray (7)CA rt�O t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
nY"4-' : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S y S�ale Fofm 43709 (R4 / 10-01) I �
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� Prescribed by DeDartment ol Laal Govemment Finance w_
INSTRUCTIONS: File Mark
To 6e filed in person or by mai! with the County Auditor o! the county whe2 the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months betore May 11 0l the year the deduction is to be effecfi've':
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the yea� tfie ded �ion is to e e�ive_
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See reverse side for addifional ins6uctions and qualifications. �
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Applicant (owner or contract 6uyer - see r s'ctions on reverce side) �� 1� �
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Taz g Di tri Key number / legal description ecord numtier�� ��0� p�� _
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Assessed value oi real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exacl share of inlerest? If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
"�e of moAgagee or contrad seller
Address of mortgagee or conlract seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what couniy? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yea(? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �a 20 20 20 Q� 20 G�a 20 �� 20 �_
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Signature � � Counry Auditor Date
�� We certify under the penalty of peryury that the above and foregoing information is true and corred and that lhe applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
. Signature (owners /ull name) Person authorized by duly executed Power of Aftomey
or by IC 6-1.1-12-.07
Fu resident address of applicant Address of authorized person
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