HomeMy WebLinkAboutMortgage_WoolstonA rt•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNEce
' � FOR DEDUCTION FROM ASSESSED VALUATION
S / Siate Fofm 43709 (R4110-01)
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Presttibe0 by Department ot Local GovemmeN Finance
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INSTRUCTIONS:
To be �led in person or by mail with the County Auditor o! the county whe2 the property i:
Filing Dates: 1) Real PropeRy: During the 12 months 6e%re May 11 of the year the deduction is tc��gf%�c�e��UL
2) Mo6ile Homes assessed under IC 6-L 1 J: Behvs�n January 15 and March 31 of lhe year the duc
See reverse side for additional insGuctions and qualifications.-- � ,�,�,,
' /p r�ggpN COUNTY
Applicant (owner or contract buyer- see 2stric6ons on reverse side)
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Taxing Distrid Key number / legal descn tion Record number
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Assessed value of real property as of I Mortgage /
March 1, cunent year �'`•`��`
Ii no, what is his / her exact share of inte
If name on record is different than that of
Name of mortgagee or contrect seller
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Address of moAgagee or contract selier (r�
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Name of assignee or other owner or holdei _. ...,,�.yaye
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amounl of:
20
Siynature
be effective.
; of Is the applicant the sole legal or equitable
owne(? ❑ Yes ❑ No
other than spouse, indicate with whom.
What Taxing Distrid?
COUNTY AUDITOR
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County Auditor
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Is the property in question:
❑ Real Property ❑ Mobile Home (IC fr1.1-�
Has lhis deduction been requested on
property for current year? � Yes � No
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Date
I/ We certify under ihe penalty of perjury that the above and foregoing information is true and corred and that ihe applicants was / were
,residenl of indiana and owner of the aforemenlioned property on March 1, 20
full name)
address
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person