HomeMy WebLinkAboutMortgage_Humphreysry" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
+�-. = FOR DEDUCTION FROM ASSESSED VALUATION
; / State Form 43709 (Ra / 10-01) �� ' � -
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PrescribeC by DeOartment of Loral Govemment Finance
INSTRUCTIONS:
To 6e (led in person or by mail with the County Auditor ol the county where the property is located. �"
Filing Dates: 1) Reaf PropeRy: Dunng Ihe 12 months before May 11 0/ the year the deduction is to be el�e�t�vc�� �
2) Mobile Homes assessed under IC 6-1 J-7: Behveen January 15 and March 31 0'fhe year fhe ded�
See reverse side !or additional inshuctions and quali�cations. ���
' GI3SON L �
COUM?y
(owner or contract 6uyer - see
Taxing Districf'' �
, I�10�1.i��omery I P
Assessed value of real property as of
March 1, wnent year
ILno, what is his / her exacl
on 2verse side)
Key number / legal description
l00 S- O I�17- 00
Record number
Page number
Zg %'�'
to 6e elfectiv�
Mortgage / ContreG indebtedness unpaid as of Is the appiicant�t�he� ole legal or equitz
March 1, current year owneR [j}�'es ❑ No
� b gq, 330.0�
Ii owned with someone other than spouse, indicate with whom.
name on record is diKerent than that of applicant, indicate below:
mortgagee or contrad seller
Address of mdrtgagee or contred Seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
or assignee �num�er and sueet, c�ry, state, LIY CodC)
❑ Real Property � Mobile Hwne (IC 61.'
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C�7 - 3�
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Does applicant own property in any other If yes, what county? I4Vhat Taxing District? Has this deduction been requested or
county in Indiana? property for curtent year? � Yes� N
approved in the amount of:
20 �_
SignaWre
20 �S/
COUNTY AUDITOR
20�x 200�
�
County Auditor
r�i7
r � i ; �i
�
� I/ We certify under the penalry of perjury that the above and foregoing information is true and wrred and that the applicants was / were
��a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (ownerslull name) Person authorized by duly executed Power o(Attorney
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o� by ic s-,.,-, z-.o�
l
"' °VM"w��� ,vaaress ot autnonzetl person
Rd2.3, ao� �la, Owens�n Ile, I►� 4�(�b�
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