HomeMy WebLinkAboutMortgage_Pate�:�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
. �� «. -J State Fwm 43709 (R6 / SO6) �
SPresaibed by Depariment of Loral Gwemrtrent Finance
JAN ?� ?�0�
INSTRUCTIONS: ile a
To be filed in person or by mail with the County Auditor o/ the county whe2 the prope�ty is located. �
Filing Dates: 1) Real Property Dunng the 12 months 6e(oie June 11 0( lhe year the deduction is to be elfech
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the gpgg�q de������efiective.
See �everse side for additional instn�ctions and qualifications.
(owneror�ntr�cl buyer-
Taxing
Assessed value of real property as of
March 1, cunent year
If name on
of
Address of
is his / her exact share of interest?
side)
Key number / legai description " � Record number
��lO��-7(/'7'L�..JOD -Odrqye�iun�uc
�
Mortgage / Contrad indebtedness unpaid as of Is lhe a�
March 1, curtent year owneR
than that of applicant, indicate below:
Name of assignee or other awner or holder of mortgage
If owned with someone other lhan
ciry, state, Z
Address of assignee (num6er and st�eet, city, state, ZIP code)
Dces applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amounf of:
20 � � 20 �`L 20
] �
Signature
sole legal or equitable
es ❑ No
indicate with whom.
❑ Mobile Hame QC 61.1-�
��'a�vej• ;�; c��
c� 0..0.,�2 _ �" �
��l�'� � •'•.
Whal i �n �y
COUNTY AUDITOR
20
County Audftor
20
20
Date
20
:quested on
❑ Yes ❑ No
certify under the penalty of perjury lhat the above and foregoing information is true and correct and lhat ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
e(owne 11 name) �� Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
resident address of applipnt (Address of aulhorized person
��S �. W'4�N�t