HomeMy WebLinkAboutMortgage_Follmer!i�`! STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
�i� FOR DEDUCTION FROM AS$ESSED VALUATION C o s p Year
�. J S�ale Form 43709 (R6 / 5-06) � .
� Respibed by Departmeni of Loral Gwemmen� Finance
INSTRUCTIONS: ��F;���
To be filed in person or by mail with the County Auditor o( lhe county where the property is located. `�
Filing Dates: 1) Real Property: During the 72 months before ,lune �l of the year the deduction is to ����p�NTY AUDITOR
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yeai the deducG'on is to be effective.
See reverse side lor additional instructions and qualifications.
�
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Applicant oH orconhactbuye�-
1
Taxing Dist id .
a%L Q�
Ass ssed v e of real pr erty as of
Mazch 1, wrrent year
on ieverse side)
Key number / legal description
a�� /%O��?da �1ao. 3G3
number
Mortgage / Contrad indebtedness unpaid as of Is the a
March 1, curtent year ownef?
�
t the sole legal or equitable
0 Yes ❑'No
Ii no, what is his / her exad share ot interest? If awned with someone other than spouse, indicate with whom.
If name on record is difterent fhan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Hane QC 61.
�m mortgagee conUaG seller
Address of mortgagee or conVad seller (number and street, city, state, ZIP
Name of assignee or ather owner or holder of mortgage
Address of
Does applicaM own
county in Indiana?
st2et, ciry, state, ZIP code)
any
Deduction approved in the amount of:
r� �r,
Signature
20
�3 :.%���
Dra��°er NO... •
If yes, what counry? What Taxii G/�����... �...... � Od 7 on
�3G(A� ...a,�No
COUNTY AUDITOR
20 20 20
County Auditor
20
20
" I
certify under the penalty of perjury that Ihe above and foregoing infortnation is true and corred and lhat the applicants was / were
lent of Indiana and owner of the aforementioned property on March 7, 20
�re (owng/s /ull�qameLq/f „� Person authorized by duty executed Power of Attomey
l ��Ff— ��� or by IC 6-1.1-12-.07
� fl �� T/! ii•—�.
��dent address ot applicanl Address of authorized person
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