HomeMy WebLinkAboutMortgage_Scheller (2)�'�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- : FOR DEDUCTION FROM ASSESSED VALUATION un � Toi'unship„ � Year
`S / Slate Fortn 43709 (R4 / 76-01) ' . : �' f
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� Prescribe0 by �epartment W Local Govemmem Finance
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INSTRUCTIONS: File�Mark
To be filed in person or by mail with fhe County Auditor of the county where the property is located. �J����
Filing Dates: 1J Real Property: Dunng the 12 months betore May 17 0l the year the deductlon is to be e�ec?i�e: OU�Tti' AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the year the deduction is to be effective.
See ieverse side for additional instructions and qualifications.
Applicant (owner o ont�act buyer- see restric 'ons on reverse side)
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Taxing Distrid Key number / legal cription Record number �
��Y 1. �' )VQO Cb �—� Page number ��
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Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtenl year March 1, curcent year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�ame of moRgagee or contrad seller
513
Address of mortgagee or contract seller (number and stieet, city, state, ZIP
Name of assignee 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? What Taxing Distrid? Has this deduction been requested on
counfy in Indiana? property for wrrent year7 [� Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 0 3 20 8 20 �� zo0� 20 �_ 20 20 �_
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Signature Counry Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is lrue and corred and that the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
Signalure (o ners lull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
u sident addr s o a li nt Address of authorized person
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