HomeMy WebLinkAboutMortgage_Smith (2)e"'rt�` � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'4-'• : FOR DEDUCTION FROM ASSESSED VALUATION
S, �y Slate Fotm 43709 (R4 / 10-01)
�� Prescdbed by Departnenl of Loral Govemment finance
INSTRUCTIONS:
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To be filed in person or by mail with the County Auditor ol the county where the propeRy is loca �
Filing Dates: 1) Real Property: Dunng the 12 months belo2 May 11 o7the year the deduction o be e ecf e. (,f,
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 Iv�yescf ded�iglwa ef/ective.
See reverse side /oradditional insWcfions and quali�cations. � GIeSCtJ C�^UU � v.:UDITOR
Applicant (owner or co ct bu er - see resf 'ctions reverse side)
Taxing Distrid ey nu er / legal description Record number Q
• Page number (�
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Assessed vatue of real property as of Mortgage / ContraG indebtedness unpaid as of Is the applicant the sole legat or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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If no, whal is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
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If name on record is diHerent than that of applicant, indicate below: Is the property in question:
❑ Real Prope+ty ❑ Mobile Home (IC 61.1-�
me of moRga ee or conlract seller
Address of mortg ee or contract seller (number and street, 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 District? Has this deduction been requested on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in fhe amount of:
20 fL,� 20 20 20 20 � 20�_ 20 Q�
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Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of the atorementioned property on March 1, 20
Signature (ow rs full name) , Person authurized by duly executed Power o( Attorney
f� •� or by IC 6-1.1-12-.07
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F resident ress of applicant Address of authorized person
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