HomeMy WebLinkAboutMortgage_JochimSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S � � Slate Fwm 43709 (R4 / 70-01)
��� PrescriDeC by DeDartmenl of Local Govamment Finance
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INSTRUCTIONS:
Count Township Year
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JUL 1 �'F��Q,Qa�
To be filed in person or by mail with the County Auditor o/ the county whe2 the property is located� �
Filing Dates: 1) Real Property Dunng the 12 months befo2 May 11 0l the year the deduction is t�6e effectiv�e. �. � O
2) Mo6ile Homes assessed under IC 6-1 J-7: Behveen January 15 and March 31 o�ffie"�eai fhe dedudion`isto be ef/ective.
UIuJUN GUVNI Y AUDITOR I
See reverse side Ior additional instructions and quali�ca6ons.
Applicanl (owne contract 6uyer- se strictions o verse side)
Taxing Dislri K y mber / legal description Record number
aoo3- a/a
� �y'�� �� �%/ �Q Page number
C�C/ �
Asse ed va of real prope as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
Mar 1, w nt year March t, current year owne(? [�'�es ❑ No
J`� / 000
If no, what is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
[J,R al Property ❑ Mobile Home QC Crt.1-�
�me of mortgagee or conVact seller `n /
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Address of moRgagee or conVad seller (number and street, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has lhis deduction been requested on
county in Indiana? property for curtent yeaf? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 fz� 20 20 Q �T 20 � 20 .� 20 �_ 20
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Signature County Auditor Date
�/ We certify under the penalty of perjury lhat the above and foregoing infortnalion is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ull name) Person authorized by duly executed Power of Attomey
a C��� or by IC 6-1.1-12-.07
ull resid t address of applipnt Address of authorized person
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