HomeMy WebLinkAboutMortgage_Douglas�. �.
�aa �" � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS —
�i�; FOR DEDUCTION FROM ASSES$ED VALUATION u� sh Year
'. .J State Fortn 43709 (R6 / SO6) . .
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� Presoibed by DeparVrent of Lo�al Govemment Finance
INSTRUCTIONS: �� �� Maric
To be filed in person or by mail with the County Auditor of the county where lhe propeRy is located.
Filing Dates: 1) Real P�operty: Dunng the 12 months be%re June 17 of the year the deduction �5�����l;V�TY AUDITOR
2) Mobiie Homes assessed under IC 6-L 1J: Between January 15 and March 2 of the yea� the deduc6on is to be eHective.
See �everse side for additional instnictions and qualifrcations. .
Applicant (ownero contract buyer- see 2stqctions �everse side) ^
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Taxing strid � Key num r/ le I descriplion
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Assessed value of real property as of Mortgage / Contrad indebtedn
March i, current year March 1, current year
If no, what is his / her exad share of inlerest?
If
If name on record is different lhan that of applicant, indicate below:
�e of mortgag e or contrad selier }/✓}�
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Address ot moRgagee occontrad seller (num er and street, city, state,ZlP
Name of assignee or other owner or holder of mortgage
of assignee (numberand st2et, city, state, ZIP
Does applicant own property in any other I If yes, what counry? T
county in Indiana?
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approved in the amow
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Signature
�Ca`�QY\�•'..WS�
Cara'��°ao5oo� —
Counfy Auditor
O Record number � �
Page number � ��
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unpaid as of Is the appli t the sole legal or equitable
owneR es ❑ No '
wifh someone other than spouse, indicate with whom.
�g Distrid?
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Is
❑ Mobile Home QC Cr1.1-�
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Has this deduction been requested on
property for wment year? � Yes ❑ No
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certiy under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full iesident address of �lipnt IAddress of authorized person