HomeMy WebLinkAboutMortgage_Hart (3)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� i Siate Fwm 43709 (RS / 4-03) . � � � ' � �
� �r• .
Prescribed by Deparimeni of �ocal Govemment Finance �
� '0
INSTRUCTfONS: � File Mark
To be filed in person or 6y mail with the County Auditor ol the county where the property is located.
Filing Dates: 7) Real Property: During the 12 months before May 11 of fhe year the deduction is to be eHective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be effective.
See reverse side for additional instructions and qualiTcations.
{owner or contract buyer
Dislrid
on reverse
JY�`�.� ry .
Key number / legal description
' O �ooi
Assessed value of r al property as of MoRgage / Contred ii
March 1, current year March 1, current year
�
If no, what is his / her exaa share of interest?
If name on record is differeni than thaf of applicanl, indicate below:
of moAgagee or conVaIX seller
Address ot mortgagee or contract
Name of
Address of
or other owner or
street, city,
mortgage
and s6eet, city, state, ZIP code)
Record
�'O � Pagenumber
�ss unpaid as of Is the ap�
owne(?
t the sdle legal or equitable
❑ Yes ❑ No
If owned wifh someone other than spouse, indicate with whom.
Does applicant own property in any other I If yes, what counly? � What Taxing Distnct?
county in Indiana?
Dedudion approved in the amount of:
20 � 20 _�$_
V �
Signature
COUNTY AUDITOR
20 �J 20 20
�
County Auditor
��
Is the property in question:
❑ Real Property ❑ Mo6ile Home QC 61.1
Has this deduclion been requested on
property for wrrent year? Q Yes ❑ No
20
Date
3�7
certify under ihe penalty of perJury that the above and foregoing information is true and corred and thal the applicants was / were
lent of Indiana and owner of the aforementioned property on March t, ZO
Signature
address
Person authorized by duiy executed Power of
or by IC 6-1.1-12-.07
of authorized person