HomeMy WebLinkAboutMortgage_Hurt (3)� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSEO VALUATION Coun Township Year
�+ � � ♦ State Fwm 43709 (RS / 4-03)
PresaiDed Dy Department of Loral Govemment Finance
RUCTIONS: File Nlark
oe filed in person or by mail with the Coanty Auditor of the county where the property is locate� �� ,�""1
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is [o4be effectiveJ ��
2) Mo6ile Homes assessed under IC 6-1.1-7: Belween January 15 and March 2 0/ the yea ��e�d U�trqLU.$�o be ef(ective.
See reverse side lor addiUonal instructions and qualiTcations.
U
Applicant (owner or
y nurtiber / legal d
0 /�--ob
� � Page
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year March rrent year owner? ❑ Yes ❑ No
�10 �OO'o
If no, what is his / her exact share of
name on
mortgagee or contract
of mortgagee or contrect seller (number and sfreet, city,
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 county?
wunty in Indiana?
20
Signature
approved in the amount of:
20 �_
f owned with someone other than spouse, indicate with whom.
ZIP
What Taxing District?
�rah,er ���nIT\
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�a~�t,rp �O! ' f � � z
20 G��'�-Cy � � ,.. � ,
� � I C` �7 7C..
County Auditor � �
s the property
❑ Real Prnperty ❑ Mobile Home (IC E1.1-7)
�
Has this deduction been requested on
property for current year? ❑ Yes❑ No
20 ��� � 20
We certify under the penaliy of perjury that the above and foregoing information is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
lull name)
Person authorized by
or by IC 6-1.1-12-.07
of authorized person