HomeMy WebLinkAboutMortgage_Smith (16)°`��'� STATEMENT OF MORTGAGE OR CONTRACT 1NDEBTEDNESS
e s
: FOR DEDUCTION FROM ASSESSED VALUATION
t > � State Fortn 43709 (R3 / 10.00) �
PreSCnbed by State Boartl ofTa<COmmissioner5
Instructions 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 effedive. See
reverse side for additional instruclions and qualifiwtions.
�FI_ 4�:?:1
Applicant (owner o ntract 6 er - rest tions on r�verse side)
Taxing Districl Key number / legal description Record number O
Q( i �O � � �oO Page number
� ,
Assessed value of real property as of Mortgage / ontraci indebiedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? ❑ Yes ❑ No
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 lhat of applicanl, indicate below:
t of moRgagee or contred seller .
Address of moAgagee or contrad seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own real property in any if yes, what county? What Taxing Distrid? Has this deduction been requested on
other county in Indiana? property for wrrent year? � Yes � No
COUNTY AUDITOR
Dedudion approved in the amounl of:
zo � 2 zo 2o zo � zo Q� zo 0'1 zo ��
5 � � P P
Signature County Auditor Date
e certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
i ent of iana and owne f the aforementioned property on March 1, 20
Sign re s e) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Ful esi d ress f applicant Address of authorized person