HomeMy WebLinkAboutMortgage_Mossberger (2)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
-- ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� µ�� j Slale Form 43709 (R4 / 10-Ot) � �+�
Presaibe0 by DepaNrenl of Local Govemment Finance ��
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INSTRUCTIONS: APR 1 b���a�
To be (led in person or by mail with the County Auditor ol the county where the property is locat :
Filing Dates: 1) Real PropeRy: Dunng the 12 months belore May 11 of the year the deduction i� be eflecG�. � M�i �
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 31 tfi�Gea� t� tle�uction �s�n be eflective.
i� GI35or+ UNIY AU��iUr{ �
See reverse side /or additional instnictions and qualifica6ons.
Applicant (ovmer or ct buyer - see 2sM,ctionls on e side)
t.t_l �
Taxing Disirid Key number / legal description Record n ber �
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� / - c�a �3 � Page number
Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is the applipnt the sole legal or equilable
March i, current year March 1, curcent year gdp ) owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Propeiy ❑ Modle Home (IC 61.1-�
�me of mortgagee or conVact seller
� 3
Address of moAgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty? What Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? property for current yeaR 0 Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20� 20 20 2Q 20 20 20�
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Signature Counly Auditor Date
'/ We certiTy under the penalty of perjury lhat the above and foregoing information is true and coned and that the applicants was / were
resident f Indiana and owner of the aforementioned property on March 1, 20
gna re (o ers (ull na e) Person authorized by duly executed Power oi Ariomey
or by IC 6-7.1-12-.07
ul s�dent a d� o i �� �` Address of authorized person