HomeMy WebLinkAboutMortgage_Riedfordi`'rt�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
,� FOR DEDUCTION FROM ASSESSED VALUATION
5 � SlateForm43709(R4170-Ot) � � . �
� Prescribed by Department ol Lacal Govemment Finance
INSTRUCTIONS: �~ j3 � Fil, e M�ark,
To be filed in person or by mail with the County Auditor of fhe county where the property is located. j� 1, !j
Filing Dates: 1) Real Property: Dunng the 12 months 6e%re May 11 o/the year the�deduction is to be e�fective. '••--1
2) Mobile Homes assessed under 1C 6-1.1-7: Behveen January 15 and March 31 0/ the year7heJded �c�gp is to be eBective.
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See reverse side for additional inst�uctions and qualifications. (l , „
Applicanl (owner or contract buyer- see restrictions on reverse side)
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Tauing Distrid Key number / legal description
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Record number
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Page number
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03 �
Assessed value of real property as of MoRgage / Conlract indebtedness unpaid as of Is the applicant the soie legal or
March 1, curtent year March 1, current year owneR � Yes ❑ No
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If�no, what is his / her exact share of interest?
If name on record is diHerent ihan that of applicant, indicate below:
,me of moRgagee or contraG seller
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Address o( moAgagee or contred seller (number and street, city,
2� 5� 3.�d-- S�. ����s �
Name of assignee or other owner or holde of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
If owned with someone other than spouse, indicate with whom.
ZIP
�perty in question:
Pmperty ❑ Moble Home (IC 61.
Does applicant own property in any other If yes, what counry? What Taxing District? I Has this dedudion been requested on
counry in Indiana? property for current yeaR� Yes❑ No
�eduction approved in the amount of:
20 20 20
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Signature
COUNTY AUDITOR
20 (')7S
T
County Auditor
20 � 20 _
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Date
20
I! We certify under the penalry of perjury thal the above and foregoing information is We and corred and that the appiicanis was / were
a resident of Indiana and owner of lhe aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 '�
of authorized person
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