HomeMy WebLinkAboutMortgage_Hennessy`° rt� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-- . FOR DEDUCTION FROM ASSESSED VALUATION
;' ' � J Slat¢ FOrm 43709 (R4/ 1P07) . . . � . '
_ .«.
� Presmbed by DepaMien( W Loral Govemmeni Finance
INSTRUCTIONS:
To be filed in person or by mail with lhe County Audifor o/ the county whe2 the property is locarea-
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to 6e
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the y
See reverse side for additional rnstructions and qualifica6ons. /;
�ppucam wnerorconrracrnuye�r.-/s
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Taxing Dislrid
�
Assessed value o( real property as of
March 1, wrrent year
no, what is his / her exact share
on
et�ect�e.� g 2003
ear �/ie deduclion is to be ellective.
V
Key number / legal desciiplion Record n b
03- �f
Page number
o �-ooa9g'- �
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenl year owneR ❑ Yes ❑ No
If name on record is different than that of applicant, indicate below:
of mortgagee or conhad
Address of mortgagee or contract seller (number and street, city,
of assignee or other owner or holder of mortgage
of assignee (num6er and street, city, state, ZIP code)
Does appliqnt own property in any olher If yes, what county?
county in Indiana?
Deduction approved in the amount of:
�/��
Signalure
If owned with someone other lhan spouse, indicate with whom.
Y�'r
What Taxing Distrid?
COUNTY AUDITOR
��Z'�E'��7/f►�F��]
County Aud'Aor
Is the property in question:
❑ Real Property ❑ Mobile Home pC Cr1.1-�
Has this deduction been requested on
property for curtent yeaf? �] Yes� No
20 � 20 _
P
Date
20
�
/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
resident of Indiana and owner of ihe aforementioned property on March 1, 20
�n ture (owners full name) Person authorized by duly executed Power of Attomey
�j� ,�/ _ _ � � or by IC 6-1.1-12-.07
person