HomeMy WebLinkAboutMortgage_Garrett (9)rt�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
+`- � FOR DEDUCTION FROM ASSESSED VALUATION C---ogggun Township Year
�, �., J• Slate Fofm 43709 (R4 / 10.07) ' . - � � 3 � �
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� Presaibed by Department of Local Govemment Finante
INSTRUCTIONS: Ft� , � �I�eOMark
To be (led in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: f) Real Property: During the 12 months be/o2 May 11 of the year the deduction i���to b�e e�ffe�e, ��c.�:.��c�
2J Mo6ile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 oi��e��ear fhe�deductiontis_to be eHective.
See reverse side for additional inshuctions and qualifications.
Applicant ( �rictions on reverse side) Q
� ) � � �''
Taxing Dislrid Key mber! legal descriplion Record number
C� O � — Sy
l b\ o0 5- oa � ��� _� Page number
Assessed value of real properry as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year Mar�1, current year owneR ❑ Yes ❑ No
C..OQ ��Q,
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Prope�iy ❑ Mobile Home QC Cr1.1-�
�me of moRgagee or contrad selier �/
3
Address of mortgagee or contraIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? Whal Taxing Dislrid? Has this dedudion been requested on
county in Indiana? property for cunent yeaf? ❑ YesO No
� � _ 1 COUNTY AUDITOR
Deduction approved in lhe amounl of:
20�� zoo zo D 2o D.- zo ny zo� zo�
a p7�D6,� f
Signature County Audilor Date
'/ We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and thai ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Si nature (owne/s (u�me� Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�ull reside� ddress of applicant Address of authorized person
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