HomeMy WebLinkAboutMortgage_Denning (2).,.,,
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�� Siate Fwm 43709 (RS / 4-03) . � �
P2scnDed by Department ol Local Govemment Finance
AUG 1 2 2005
fNSTRUCTIONS: File Mark
To be /iled in person or by mail with the County Auditor of the county where the propeRy is located �
Filing Dates: 1J Real Property: Dunng the 12 montAs before May 11 of the year the deduction is ro 6e eHecWe a� ,�
2) Mobile Homes assessed under IC 6-1J-7: 8etween January 15 and March 2 o/the ye��p�Nde�d� �b�e��ctive.
See reverse side /or addifional instructions and qualifications.
Applicant (owne� or confract buyer- see restrictions on reverse side) �
� � �
Taxing Districl -� �� Key number / legal descr tion Record number /1
V `�'r
Page number
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Asses d value of al property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant t sole legal or equitable
March 1, current ye r March 1, current year owneR. ❑ No
If no, what is his / her exact share of interest? If owned with someone olher than spouse; indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
�3me of moRgagee or contrad seller ��OP�Y � Modle Home pC 61.1-�
��
Address of mortgagee or contract seller (number and street, city, sfate, ZIP
Name of assignee or other owner or holder of mortgage �
Rddress of assignee (number and street, city, state, ZIP code) - "
Does applicant own property in any other If yes, what counry? �m ��� �
�een requested on
counryinlndiana? Drawer��•�hM ••.••.. �ear?�]Yes�No
On.N�
COUNT CardNO. ��;�.
�.
Deduction approved in the amounl of: _ � � -
zo d zo �� zo �� zo zo zo zo
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Signature County Auditor Date
�! We certify under the penalty of perjury lhat the above and foregoing intormation is true and corred and thal lhe applicants�was /�were
a resident of Indiana and owner of th atorementioned property on March 1, 20
Sig e( ner 11 name) ,� Person authorized by duly executed Power oi Attomey
��� c or by IC 6-1.1-12-.07 �
Ful resi address of applicant Address of authorized person
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