HomeMy WebLinkAboutMortgage_GriffinSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION �-�
++ _ / State Fwm 43709 (R514-03) � O
� PreSCriEed Oy Departmeni of Loral Gtivemment Finance � �
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Coun Township Year
INSTRUCTIONS: File Mark
To 6e fifed in person or by mail with the CotintyAUditor o/ the county where fhe property is locafed. =''
Filing Dates: 7) Real Property: During the 12 months be%2 May 11 0/ the year the deduction is to 6e effective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be eHective.
See reverse side for additional instructions and qualifications.
Tauing Distrid v
I�� V'�+
Assessed value ofrealproperty as of
March 1, curtent year
no, what is his / her exact
on
Key number / legal
Record number
['�[�� ,(I)��(�/!OT Pagenumber ��
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Mortgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or i
March 1, current year owner? �es ❑ No
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If owned with someone ottier than spouse, indicate wilh whom.
If name on record is different than ihat of applicant, indicate below:
�me of mortgagee or contrad seller
AK�Cl' O
Address of mortgagee or contrect seller (number a st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(m�mbe�and street, city, state, ZIP
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Does applipnt own property in any other I If yes, whal county? � What Taxing Distrid?
county in Indiana?
�
Signature
approved in the amount of:
20 �
COUNTY AUDITOR
20 � 20 O � 20
�
Couniy Auditor
s the property in question:
❑ Real Property ❑ Mobile Home (IC 61.
Has this dedudion been requested on
property for current yea(? 0 Yes ❑ No
20
Date
20
certify under the penairy of perjury thal the above and foregoing information is We and corred and lhal the applicants was! were
eM of Indiana and owner of the aforementioned property on March 1, 20
ire (owners ful! name) /� Person authorized by duly executed Power of Atlomey
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�! aPP�A��, n e- � /�^� IAddress of authorized person
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