HomeMy WebLinkAboutMortgage_Elpers (43)�'" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS --
"_ ' FOR DEDUCTION FROM ASSESSED VALUATION �-`C `nt n� w� hip Year
�, .• . J Stale Form 43709 (R4 / 10-01) �
� Presttibea by Deparurent of Local Govemment Finance
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INSTRUCTIONS: �J� File/INa
To 6e filed in person or by mai! with the County Auditor ol the county whe2 the property is ca ed �-�-(,
Filing Dates: 1) Real Property: Dunng the 12 months belo2 May 11 0l the year the deduction�rls�be effecti've: AUDITQP .
2J Mo6ile Homes assessed under IC 61.1-7: Behveen January 15 and March 31 0/ the year the deduction is to be elfective.
See reverse side for additional instructions and qualifications.
Applicant (owner or on ct buyer - see restrictions on verse sde)
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Taxing Distrid Key number / legal description Record number ��
l.�l/k�lc'rv' �d7 — Q �`1 � 3 Cat� �
� Page number
Assessed value of real properry as of Mortgage / Contrad indebtedness unpaid as of Is the applican the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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I( no, what is his / her exact share of interest? I( owned with someone other than spouse, indicate with whom.
If name on record is different than tFiai of applicant, indicale below: Is the property in question:
❑ Real Property ❑ Mobite Home (IC 61.1-�
�ame of moAgagee or contrad seiler �
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Address of mortgagee or contract seller (number and st2ef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and sheef, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
counfy in Indiana? property for curtent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 fI�? 20 � 20 20 20 �� 20 �_ 20 0
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Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Si natur owners I name) Person authorized by duly executed Power of Attomey
� p or by IC 6-1.1-12-.07
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ull nt ddress pplican Address of authorized person
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