HomeMy WebLinkAboutMortgage_Overfield�'�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION �� Coun Township Year
! SUte Fortn 43709 (R6 / 5-06)
� Resaibed by Departmer,t of Lo�l Govemment Finance
JUL 1 1 2001
INSTRUCTIONS: File Mark
To be filed rn pe�son or by mail with the County Auditor o( lhe county whe�e fhe p�opeRy is I �
Filing Dates: i) Real Property: Dunng the 12 monihs be(oie June 17 of the year the deductio �s
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and M�{�g�f Ny�p��t���q'�(ion is to be eflective.
See reverse side for addilional instructions and quali�cations. �
contrdct buy - see
Lp � �J�PJ
Taxing I
on reyerse side)
Key num6er / legal desuiption � Record number
'� a�-�9-�9-�03-000, sss-o �enumber
Assessed value of real property as of Mortgage / Contract indebledness unpaid as of Is the applicant t e sole legal r f
March 1, current year March 1, current year owner? �❑ Yes ❑ No
\i�
3 Od '`�"
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
SP�Orid� adi
If name on record is different than ihat of applicant, indicate below: Is the property in question:
of mortgagee or contrad
Address of moRgagee or contrad seller (number and street, city,
Name ot assignee or other owner or holder of mortgage
Address of assignee (number and sheef, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
approved in the amount of:
20 �_ 20 c�`L
� �
Signature
3 S�
20 I 20
County Auditor
What T
AUDITOR
I [o
❑ Mobile
U� ;t' `,C' `l,O -
c�. . n��.S
'�/-��l, '
_ ° �;�ysa�� .
�a�: p •.
�.
�
61.
on
No
We certify under the penalty of perjury that the above and foregoing information is true and correct and lhat the applicants was / were
resident of Indiana and owner of the �forementioned property on March 1, 20
executed Power of Attomey
or by IC 6-1.1-12-.07
of ap�l�Ea" ni �Address of authorized person