HomeMy WebLinkAboutMortgage_Pohle`°���' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�-' = FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Ye:
� �, .. > State Form 43709 (R4 / 10.01) . - .
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Prescribe0 by Depanment o1 Lacal Govemment Finance
INSTRUCTIONS: ile a;
To be filed in person or by mail with the County Auditor ol the counfy where the property is I
Filing Dates: i) Real Property: Dudng fhe 12 months be%re May 11 oJ the year the deductio� '_� �ective��
2) Mobile Homes assessed under IC 6-1.1J: Between January 15 and March 3 0/ th jyeart�ie'deduclion is to 6e eHectivi
See reverse side foradditional instructions and qualifications. �.�H� U � ���3
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or contract buyer- see restrictions on reverse side)
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Assessed value of real property as of
March 1, current year
no,
exact share of interest?
Key number / legal descriptio
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.�n-� r 9 _ �
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Record number
�D�
Page number 2
MoRgage / Contrad indebtedness unpaid as of Is lhe applicant the s legal or e
March.l,currentyear owneR es ❑ No
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If owned with someone other than spouse, indicate with whom.
name on record is different than that of applicant, indicate below:
Name of moAgagee or contrad
Address of
Address
❑ Real Property ❑ Mobile Home (IC 61.'
or contrect seller (num6er and street, city, state, ZIP
or o�ner owner or noiaer ot mongage
�numoer ano srreer, c�ry, stare, t�r
Does applicant own propeAy in any other
county in Indiana?
Deductlon
�J/F]
amount ot:
�-,
what county? What Taxing District? I Has this dedudion been requested or
property for current year? [� Yes � N
COUNTY AUDITOR
F��j�OI.L��
County Auditor
zo n•r 20�_ zo 0
P P P
Date
�I/ We certify under the penalry of perjury that the above and foregoing information is true and correct and that the appiicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attorney
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or by IC 6-1.1-12-.07
of
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autnonzea person