HomeMy WebLinkAboutMortgage_MarshallSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S M! Stata Fortn 43709 (R5 / 4-03)
� PtesaiEed Cy DepaRmen; of Lccal Govemment Finance
INSTRUCTIONS: File Mark
To 6e filed in person or 6y mail with the County Auditor of the county where [he property is located.
Filing Dates: 1) Real Properry. During the 12 months be%re May 11 01 the year the deduction is to 6e effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the deduction is to 6e effective.
See reverse side (or addiUonal instnictions and qualfications.
Applicant erorcontract buyer- see resMcfions on 2verse side)
Taxing Di rid Key number / legal desaiption Record number �
�/�y�,,� ' -_ ^ _ Page number
�'\./\.�/Y �
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, cunent ear owne(? ❑ Yes ❑ No
���a�
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate wilh whom.
a -� - - 03 - . a a
If name on record is different ihan ihat of applicant, indicate below: Is the prop�erty irt�q�estion:
1! l.Rea Protiperty ti � M�' ome pC fr1.7-�
�me of moAgagee or contred seller � Jl- �"" �
Nnv � 6 2005
Address of mortgagee or cont�act seller (number and street, city, ate, ZIP
;371c�:,'a�(f
Name of assignee or other owner or holder of mortgage � TY A
G�BSp,y COUN 1
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current year? � Yes � No
' COUNTY AUDITOR
Deduction approved in fhe amount of:
20 20 20 �'� 20 � 20 20 20
� � $ �
Signature County Auditor Dale
We certify under the penalry of perjury that the above and foregoing information is true and corred and lhal ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 7, 20
Signature (owners /ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
F esident address of applicant Address of authorized person
SO L/? �'