HomeMy WebLinkAboutMortgage_Icery" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' s FOR DEDUCTION FROM ASSESSED VALUATION _yyCounq Township Year
� � / Slate Form 43709 (R4 / 10-01) � � � , �� 9
PrescribeG Dy DepaNren� ot Local Govemment Finance
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D E C 2� 200Z
INSTRUCTIONS: File Mark
To be filed in person or by mail wifh the County Auditor of the county where the property is locate� �
Filing Dates: 1) Real Property: Dunng fhe 12 months before May 11 0/ the year the deduction is c�`y.8j„
2) Mobile Homes assessed under IC 6-1.1-7: Belween January 15 and March 31 of they'�fL,Yh�i�ledfrctio��is �6e eNective.
See reverse side /or additional instructions and qualifica6ons.
Applicant (ownerorcontract buyer- see rest�c6ons on reverse side)
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Taxing District Key ber J legal description Record number ^
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. Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, current year March 1, curtent year owner? �es ❑ No
1 �- I,� �oo
If no, what is his / her exact share of interest? I owned with someone olher than spouse, indicate with whom.
If name on recard is difierent than that of appticant, indicate below: Is the property in quesiion:
eal Property ❑ Mobile Home QC &1.1-n
e of moAgagee or contrad seller
Address of mortgagee or contred seller (number and sheet, aty, state, ZIP
Name of assignee ar other owner or holder oi mortgage
Address of assignee (number and sGeet, city, state, ZIP code)
Does appliqnt own property in any other It yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 e.; 20 D 20 20 20 20 � 20 _�
P Q P
Signature County Auditor Date
/ We ceAiry under the penalty of perjury that the above and foregoing infortnation is We and coned and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signat (owners (ull name) Person authorized by duly execuled Power of Attomey
�` or by IC 6-1.1-12-.07
II resident addres f a,�ptpl,icant � Address of authorized person .
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