HomeMy WebLinkAboutMortgage_Hessler`° �'�°° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`�" :. FOR DEDUCTION FROM ASSESSED VALUATION
�S � J State Fortn 43709 (Ra / 10-01)
Prescnbetl Dy Deparirtrenl ot Loral Govemment Finance
Year
INSTRUCTIONS � � File �
7o be filed in person or by mail wifh the County Auditor o/ the county where fhe property is loc� �
Filing Dates: 1 J Real Property: During the 12 months beloie May 11 of the year the deduction is to 6��ct�e� 70Q2
2) Mobile Homes assessed under IC 61.1-7: Between January 15 and March 31 0/ the th d'edu`ction is to be effective.
See reverse side lor additional instructions and qualifications. � �� n�
Appli fi (ownerorcontractb er-see n
Tauing Distnd
�t� / G(.!
Assessed a e of real pr riy as o
March 1, ent year
If no, what is his / her exacl share of interesl?
ions on reverse side)
i- v��.,,,._ - -
�'1�C �2
Key number / legal description Record number
�/ Page number
0� 3Jlo DU
Mortgage / Conlrad indebtedness unpaid as of Is the applicant the sole egal or equitable
March 1, current year owneR ❑ Yes ❑ No
C�O o 0
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appticanf, indicate below:
,ame of mortgagee or contract selier ���
�di�
Address of mortgagee or conVaIX seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand streef, city, state, ZIP code)
Does applicant own property in any
county in Indiana?
Deduction approved in the amounl of:
20 Q,�_ I 20 Q�
If yes, what county? � What Taxing Distrid?
COUNTY AUDITOR
20 20 � 20
County Auditor
Is the property in question:
❑ Real PropeAy ❑ Mobile Home pC 61.1-
Has this dedudion been requested on
property for current yea(? � Yes ❑ No
r� i
�
Date
20 ��
�
I/ We certify under the penalty of peryury that the above and foregoing information is true and corred and lhat the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person