HomeMy WebLinkAboutMortgage_Deal (6)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yes
FOR DEDUCTION FROM ASSESSED VALUATION
S State Fwm 43709 (RS / 4-03)
� Presaibe0 by Department of Laal Gc•remment Finance
i g
INSTRUCTIONS: � C � FpP'Ma�
To be filed in person or by mail witA the CountyAuditor of the counry where the property is locate g�� �� �.I
Filing Dates: 1) Real Property: During fhe 12 months before May 11 of the year the deduction is to be e/fg�ti•v'e.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the yearJYr�Yle�luQio�6o be effective.
See reverse side for additional inshu ions and qual�cations.
� .;�r� ,a�,
Applicant (owne� or confract bu r ee restri
/v�
Taxing Distrid
A sessed value of real r rty as of
March 1, wrtent year
If no, what is his / her exad share of interest?
on
Key number / legal description
S'
Qj� �� /� � /��_ Page number�'/
U CJo�! 7
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or e
March 1, cunenl year owneR ❑ Yes ❑ No
0 4 O �
If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
,me of mortgagee or contrad seiler �
Address of moRgagee or cont�ad seller (number and stree , city, state, ZIP
Name of assignee or other owner or holder of morigage
(number and sheet, city, state, ZIP code)
Does applicant own property in any other I If yes, what county? What Taxing District?
county in Indiana?
Deduction
20
Signature
COUNTY AUDITOR
in the amouni of:
20 � /� 20 �_ 20 20
/
County Auditor
❑ Real Prop�iy ❑ Mobile Home
Has this dedudion been requesled on
property for cunent year? ❑ Yes 0 No
�
Date
20
We certify under ihe penalty of perjury that the above and foregoing information is true and correcl and that the applicants was / were
��ent of Indiana and o� n i of the aforem�ioned property on March 1, 20
natu (owners (ull nam ) Person aulhorized bv dulv executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person