HomeMy WebLinkAboutMortgage_Douglas (3)�
' ,., .
�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �,Coun ' Township Year
FOR DEDUCTION FROM ASSESSED VALUATION T� �1 (
State Fwm 43709 (RS I 4-03) }! � F J �
� }�
PrescriGed by Oepartment of Local Govemment Finance
Il • i C
1/LV 1V
INSTRUCTIONS: � (, File Ma�
To be filed in person or by mail with the CountyAuditor ol the county where the propeRy is located. � ;�,,r..�
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction'is'to:be eflective; ;;UDiTOR
��• r�n�vrl.,.,.,..
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduc[ion is to 6e ef%ctive.
See reverse side for additional insfructions and qual�cations.
Applicant (own o contract buyer - see restric ' s on 2verse side)
a�s- '4� �- �a7�:� �
Taxing District Key number / legal description cord number y�
(/
/J'1^ �' O �I� Pagenumber �� �
'(JV
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicani the sole legal or equitable
March 1, curtent year March 1, current year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest? " If owned with someone other than spouse, indicate wiih whom.
If name on record is different than that of applicant, indicate below: Is tne property in question:
'-' "zl Property ❑ MobBe Home (IC E1.1-7)
'� �_ of mortgagee or contract seller �_ pd �
�e
I
DrawerNO. ........�......./
Address of mortgagee or contred seller (number a
Card n`O . .....................
Name of assignee or other owner or holder of mort�
a
Address of assignee (number and street, city, state, ZIP code)
Does appficant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo 0 2o za n f, zo � 2o a Y 20 �°L zo
PY'1� �o � � �° '�
Signature County Auditor Date
�We ertiTy under the penalty of perjury that the above and foregoing infortnation is true and correc[ and that the applicants was / were
d of Indiana and ow f the a entio property on March 1, 20
i re owner's (ull nam Person aulhorized by duly executed Power of Attomey
' ar by IC 6-1.1-12-.07
esident address of applicant Address of authorized person
3 ` � s