HomeMy WebLinkAboutMortgage_Rainey� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S� � �' S�ale Fofm 43709 (R4 / 70-01)
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� PrescribeA by Depanment ol Local Govemment Finance
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INSTRUCTIONS: � � p� Mar�
To be filed in person or by mail with the County Auditor o/ the county where the property is /ocated. ���
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 0/ the year the deduction is fo 6e elfective.���7. 1
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the year the dQauoao�i5to��e�eHective.
See reverse side (or additional instiuctions and quali�ca6ons. �, � U, n �
Applicant
see 2�trictions on reverse side)
Tauing Disirid V
t/' V �M�/' ,
Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exact share of interest?
number /
�O�I=DI� 80-
March 1, current year
�teaness unpaia as
J� -� !
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If owned with ;
( �� ia
If name on record is different than that of applicant, indicate below:
�me of mortgagee or conVad seller
' � �
Address of mortgagee or contrad seller (number and street, city, state, ZIP
�. �%. %��C �71C 7� y� �9 / �i,
Name of assignee or other owner or holder of mortgage n
of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any
county in Indiana?
r��
Deduction approved in the amount of:
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Signature
If yes, what county? � What Taxing Distrid?
COUNTY AUDITOR
�vj,��m!���
County Auditor
Record
Page
Is the applicant the sole legal or
owneR � Yes ❑ No
than spouse, indicate with whom.
`�Real PropMy ❑ Mobile Horrie QC 61.
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aia97- /G77
Has this dedudion been requested on
property for wrrent year? � Yes ❑ No
20 � 20 _� 20 � `
P 6' P
We certity under lhe penalty of perjury that the above and foregoing infortnation is true and corcect and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
a�r(o'�lull name) ^�' Person authorized by duly executed Power of Attomey
� j� or by IC 6-1.1-12-.07
naaress oi au[nonzea person
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