HomeMy WebLinkAboutMortgage_Nelson (8)��'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
:= FOR DEDUCTION FROM ASSESSED VALUATION
S � S�ate Form 43709 (R4/ 70-07)
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Prescribed by Department ol Loral Govemment Finance
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INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor o/ the county where the property is
Filing Dates: � Real Property: During [he 12 months before May 11 0l the�ear the deduction is tq=t�e�l(�c�v���
2 Mobile Homes assessed under IC 61.1-7: Between Janua 15 and March 31 0/ the ea t tion is to be eHective.
See reverse side (or additional instructions and qualifications. � /�1 n n
Applicant
Taxing District
L�v i�I.CJ/� �
Assessed value ofreal
March 1, wrrent year
on
Key number / legal�descriplion Record number O
/� � Page number D C
(J J
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as of Mortgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
Ma�current year o� owne(? ❑ 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 Property ❑ Mobile Home (IC 61.
of moAgagee or contrad seiler �/�
Address of mortgagee or contrad seller (number andstreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
sheet, city, state, ZIP code)
Does applicant own property in any
counry in Indiana?
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Signature
approved in lhe amount
If yes, what county? What Taxing Distrid? Has this deduction been requested on
property for current yeaf? � Yes ❑ No
COUNTY AUDITOR
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Counry Auditor
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1 �
Date
20 O 9
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/ We certify under the penalty of peryury 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
gqature (owne/s full hame) Person authorized by duly executed Power of Attomey
iL, ���,�� �, ���,���_ or by IC 6-1.1-12-.07
:ss of applicant Address of authorized person
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