HomeMy WebLinkAboutMortgage_Herron�� � STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS �
i� = FOR DEDUCTION FROM ASSESSED VALUATION � � shi Year
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! State Fwm 43709 (R6 / 5-W)
� Prescribed 6y Departmenl af Local Govemment Finance MAY 1 2007
INSTRUCTIONS: �%a�„ ,C,F�a,Mark
To be filed in person or by mail with the CountyAudifor o/the county where the p�operty is loca,��j�g��¢�TY �q plTOa
Filing Dates: i) Real Property: Dunng the 12 months 6efore �une Il of the year the deduction is i�
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deducG'on is to be effective.
See reverse side for additional instruc6ons and qualifications.
Appiicant (owner o t2ct buye� - s res ' tions on reverse side)
Taxing District Key number! legal description Record number ��7
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6�' � -1 '7 � V��� • �l q 6 -oa Page number �' � �
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? � Yes � No
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If no, what is his / her exact share of interesC? 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 quesbon:
❑ Real Properly � Mobile Home QC 61.1-7)
�e oi mortgagee or contract seller /� ��
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Address of moRgagee or contract seller (number and street, city, state, ZIP
Name of assignee or olher owner o[. hoido�-^`�-�-�� �
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Address of assignee (numbe� � � IJ n� e M1
6���1/uw • �
Does applicant own property in : ��/yyy��� �� )istrict? Has this deducUon been requested on
county in Indiana? ��� � Q��, p) property for wrrent year? ❑ Yes❑ No
7 (@
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 � 20 �5 20 20 20 20
P � !
Signature Counry Auditor Date
I! We certify under the penalty of perjury that the above and foregoing infortnation is We and cortect and that the applicants was / were
sident of Indiana and owner oi the aforementioned property on Marrh 1, 20
S� tur owner (ull name) Person authorized by duly executed Power of Attomey
. / or by IC 6-1.1-12-.07
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�II sident address of appiicant Address of authorized person