HomeMy WebLinkAboutMortgage_Dilbeck (4)`A R��' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i+4-° .. �: FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
i J SWte Form 43709 (R4 / 70-01) ' � �
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PrescriDeO Dy Departmenl of Local Govemment Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of fhe county where fhe property is located -,- _
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 of the year fhe deduction is to 6e 'eNecti�e. , (,� � T� 1
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of the yea� the deduc6on'�to be ellective.
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See reverse side for additional instructions and qualificafions.
Applicant (owner or contract buyer- see restrictions on reverse side)
i��,A. �•a Debo�rti. A. D� �6�x,
Taxing District Key number / legal description
� I �ia�n��m�er��w�
Assessed value of real property as of
March t, wrrent year �
If no, what is his / her exact share of interest?
If name on record is
moAgagee or contract
kUG 11 2003
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Rewrd number "
� v �— n-
��S"� � 3 S'39 —0 � Page number
Mortgage / Contract indebtedness unpaid as of Is the a
March 1, current year owneR
' �I 39, 000• oa
indicate below:
�
s so�e iegai or
Yes ❑ No
If owned with someone other than spouse, indicate with whom.
ot moifgagee or conlrad seller (number and street, city, state, ZIP
of assignee or other owner or holder of mortgage
Address of assignee (numberand street,
Does applicant own property in any
county in Indiana?
approved in the amouni of:
r��l'm
ri •
. �� .
Signature
state, ZIP code)
If yes, what county?
What Taxing Distrid?
COUNTY AUDITOR
20 � � I 20
County Auditor
s the property
❑ Real Property ❑ Mobile Home pC Crt.
Has this deduction been requested on
property for current yea(? � Yes ❑ No
20 6 I I 20
�
Date
20
We certify under the penalry of perjury,that the above and foregoing intormation is true and correcl and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�3n re (owners 11 na e) Person authorized by duly executed Power of Aftorney
/%. _. L� ��. /� or by IC 6-1.1-12-.07 ��
; of applicant Address of authorized person
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