HomeMy WebLinkAboutMortgage_Reed (4)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSED VALUATION
` � State Form 43709 (R3 / 10-00) .
� Prewibetl C� State Boartl of Ta: Commissioners
InsUuctions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the deduction is to be eHedive. See
reverse side for additional instructions and qualfiqtions.
FORM 5
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AUG 17.2001
Fde Mark
CI9SG!� CGL`2T`:' AU�I �OR
Applipnt (owner r ntrar�( buyer- e�esUictions n�everse side)
Taxing Disfid Key number / legal description Record number O I '
�(� I I,,,, �iiln/„��1,� � Page number
�/ l wl�/ 7 .
Assessed value of real property as of Mortgage / Contrecl indebtedness unpaid as of Is the applica t ihe sole legal or equitable
March 1, current year March 1, current year. owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appliwnt, indiqte below:
�e of mortgagee or contrad seller r
✓
Address of mortgagee or conVact selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, aty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing DisVid? Has this dedudion been requested on
other county in Indiana? property for curtern yeaR � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 20 O 20 �,� 20 0� 20 � 20
s � � P P
Signature � �' Caunty Auditor Date
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I We certify under the penalty of perjury that the above and foregoing informaGon is We and corred and that rt�e applicants was / were
� ident of Indiana and owner of the aforemenfioned property on March 1, 20
Si nature (owners lull narri . Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Full resident addre applipnt Address of author¢ed person
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