HomeMy WebLinkAboutMortgage_Seibert (3)�n
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
�'. ♦ State Form 43709 (R5 / a-03)
� �«.
PrescnbeE by Department o( Loral Govemment Finance
INSTRUCTIONS: �
To be filed in person or by mail with the County Auditor of the county where the property i�� cated.
Filing Dates: 1) Real Property: During the 12 months 6efore May 17 0l the year the deduction is tQ �a3e�c6`v����
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year the deduction is to be eHective.
See reverse side for additional instructions and qualifications. �aG ��
r_iaSON COUNTY AUDITOR
Applicanf (own r�r contract buyer
Taxing Dislrid
'� � 43�
Assessed vatue of real property as of
March 1, curcent year
what is his / her exac[ share of inte
If name on record is differenl than that
moAgagee or contract
on 2verse side)
Key number / Iegai description
a�-!9 - /9-io/-(xu� 60 9 - o ��
0 � � - b�6o�-0�
Mortgage / Contract indebtedness unpaid as
March 1, current year
S_G . nx�- -
_ �• 1," J
�
" I
Record number'�oo �
Page number � � ^
�
f Is the applicant the sole legal or equitable
owneR ❑ Yes ❑ No
ne other than spouse, indicate with whom.
� 3,�.,��, ak'sl, coo.��
Address of mortgagee or contrad seller (m
Name of assignee or other owner or holder of mortgage
Address ot assignee (number and stieet, city, state, ZIP code)
s the property in question:
❑ Real Property ❑ Mobile Hane (IC Fr1.1-�
Does appliwnt own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for wrrent yea(? � Yes� No
ueauc6on approved in the amount of:
20 �_ 20 Q� 20 �
1 �
Signature
COUNTY AUDITOR
20
County Auditor
�
20
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent o( Indiana and owner of the aforementioned property on March 7, 20
(owners (ull n
n addE ress o(
�oOLj $. L�NCO�v�
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person