HomeMy WebLinkAboutMortgage_Hurt (2)e� t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS—, —' � `� ��
e'�+'�`-°'_ E FOR DEDUCTION FROM ASSESSED VALUATION CEount i"'ti Town 'ip Year
� : , Slale Form 43709 (R4/ 70-01J -
Prescribe0 q Departnent of Local Govemment Finance ,1 O� O 1 1002
1`I
INSTRUCTIONS: � � �F,ile.M�AJ'
To be filed in person or by mail with the County Audifor o/ the county where the property is IocaYetl:`^w `: �� Y qUD170n �
Filing Dafes: 1) Real Property: Dunng the 12 months 6efore May 11 0/ lhe yea� the deducfion is�to tre effec�tive,
2J Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year the deduction is to be eNective.
See reverse side (or addifional inst�uctions and qualifcafions.
Applicant (owner or
Taxing Distrid
buyer - see restrichon on reverse side)
,,.D�4�,,�f �-
u�6er / legal de
. Q � �
Page number
-oai90-�
Assessed vatue of real properiy as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
U�/ C� �C�
Ii no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of appiicant, indicate below:
of moAgagee or contract seller
Address of mortgagee or contrad seller (number
assignee or other owner or holder of mortgai
Address of assignee (num6erand street, ciry, state, ZI
Does applicant own property in any other I( yes, what c
county in Indiana?
Deduction approvedin the amount of:
20 � 20
�
Signalure
❑ Real PropeAy ❑ Mobile Home QC 61.
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n _-l--r� �JL0..
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20 ��� 20 O !F
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County Auditor
� 31,�
20 �'L 20 �
P
Date
20
vested on
Yes ❑ No
i
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authurized by duly executed Power of Aftomey
or by IC 6-1.1-12-.07
of authorized person