HomeMy WebLinkAboutMortgage_Wright (4)`°�'�'�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-° : FOR DEDUCTION FROM ASSESSED VALUATION Count Township vear
�, - J State Form 43709 (R4 / 10-01)
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� PrescriDeO by Department of Local GovemmeN Finance
INSTRUCTIONS: � File Mark
To 6e filed in person or 6y mail with the County Audi[or of the county whe2 the p�a� e �s lor�ated. �
Filing Dafes: 1) Real PropeRy: During the 12 months 6e%�e May 11 o/the year the �jeduc�n�dbe ve.
2J Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 antA6larch 31 0( th �ye�,jqe deduction is to be e/%ctive.
See reverse side /or additional instructions and qualifications. �•�p�l 1' LUU3
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Applicanl(ownero co c buyer-seerestric' n onrryv s side) �' il` �
\� r' ; �, >' �: i r AUDITOR
Taxing District Key number / legal s'p' ecord number �
/�� ' " "V' � O / � OD /� / /�r/'1 Page number � �
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Assessed value of real prope as of MoRgage�ontract indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1 enl year owneR ❑ Yes ❑ No
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If no, what is his / her exact 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 Pr�operty ❑ Mohile Hane QC Cr1.1-�
�me of mortgagee or contract selier ��
Address of mortgagee or wntrad seller (number and st et, city, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own property in any olher If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaf? 0 Yes � No
COUNTY AUDITOR
Deduction approved in the amounl of:
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Signature County Audi or Date
'/ We certify under the penalty of peryury that the above and foregoing infortnation is true and correct and that the applicants was / were
resideni of Indiana and owne the aforemenlioned property on March 1, 20
$,igc�tu (owners (ull iame) _ ' Person authorized by duly executed Power of Attomey
� T, or by IC 6-1.1-12-.07
F II resident ad s pplicant ` Address of authorized person
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