HomeMy WebLinkAboutMortgage_Cunningham`O�'�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' � FOR DEDUCTION FROM ASSESSED VALUATION
Coun Township Year
'� / Slate Fortn 43709 (R4 / 10-01)
�� PrescriDed Dy DepaNrenl ot Local Govemment Finance '� ��� ��� 1 I���
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INSTRUCTIONS: FEB O � LUeJL ark
To be filed in person or by mail with the County Auditor ol the county whe2 the propeRy is located.
Filing Dates: 1) Real Prope�ty: During the 12 months beloie May 11 olthe year the deduction is Fo be effective. �� n
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Maich 31 of the yearthe deduction is�to be etfective.
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See reverse side lor additronal instructions and qualifications. C'9S0" C_'' '-Y S!i9!TCR
Applicant (owner or contracf buyer- see re�tions on reverse side)
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Taxing Distrid Key number / legal description Re_C/pr� mber� _ 9 3a
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, , O � _ O � � ./. � _ � _ Page number
Assessed value of real properly as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, curreN year � ownef? 0 Yes ❑ No
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If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than Ihat of applicanf, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�e oi mortgagee or contract seiler
Address ot mortgagee or contract seller (number an stre t, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand 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 the amounl of:
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zo l.' � 20�� zo zo 2o zo 0 zo 0 9
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SignaWre County Auditor Date
'`Ne certify under the penalty of perjury lhat the above and foregoing information is true and correc[ and that the applicants was / were
sident o( Indiana and owner of the aforementioned property on March 7, 20
nalure (owners /ull name) Person authorized by duly execuled Power of Attorney
�� j ` or by IC 6-1.1-12-.07
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I resident address of applicant Address of authorized person