HomeMy WebLinkAboutMortgage_BeckerSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�s ! State Fartn 43709 (RS / 4-03) � ,.� _
� �
P25cnEed by DepaMrem of Loral Govemmeni Finance
iNSrRUCrroNS: MAR 2 g�C�09�
To be filed in person or 6y mail wiih the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: Dunng the 12 months 6efore May 11 of the year the deduction is to 6e ellective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 of the year the �t%{��k to be eHective.
See reverse side for additional instructions and qualifications. �;;�. �; ,.. ,; ��!�TY AUDITOR
Applicant (ow or contract bu - see
Taxing Disirid
.
Assessed value of real property as of
March 1, current year
If no, what is his / her exacl share of inte
If name on
on reverse
K,�y ir JrpTjer / legal description
v vv
� � � 3a3-o�
Mortgage / Contrad indebtedness unpaid as ol
March 1, current year
35.�
than that of applicant, indicate below:
of mortgagee or contrad seller
of mortgagee or wntract selier
Name of assignee or other owner or holder of mortgage
Record number �
Page number � � � ,,,
Is lhe applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
ZIP
� �❑ Real Property ❑ Mobile Home pC 61.
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid?
county in Indiana�
- COUNTY AUDITOR
�eduction approved in
20..�"L. 20
P
Signature .
fhe amount of:
� 20 0 20 20
� P �
County Auditor
Has this dedudion been requested on
properly for current yeaf?� Yes� No
20
Date
20
We certify under the penalty of peryury that the above and foregoing information is true and correct and that the applicants was / were
esident of Indiana and owner of the aforemenlioned property on March t, 20
nature (owners full name) /� Person authorized by duly executed Power of Attomey
.�.. _ �_ .� .1� .. . �0 n _ _ or by IC 6-t.t-12-.07
authorized person
0
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