HomeMy WebLinkAboutMortgage_McConnell� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�s� � �� �✓ ' Stata Fortn 43709 (R5/4-03) `/"—)
�`/ PrescnDed by Depanmem o: Local Govemment Finance �7 /
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INSTRUCTIONS: � File Mark
To be filed.in person or by mail with the County Auditor of the county whe�e the property is located.
. Filing Dates: 1) Real Property: Dunng the 12 months be(ore May 11 0/ the year the deduction is to be eBective.
. 2J Mobile Homes assessed under IC 6-1.1-7: Between January 75 and Maich 2 of the year the deduction is to be effective.
See reverse side tor additional instructions and quali�cations.
see
Taxing
on
Key number / legal description
bOJ" b�s� Q'�� Page number
�7/ro
Assessed v�lue of r�l property as � Mortgage / ContraG indebtedness unpaid as of Is lhe applicant lhe sole legal or equitable
March 1, curtent year , March 1, current year owneR ❑ Yes ❑ No
� O�
If no, whaf is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the propertyin question:
� — -- „ _ ❑ Real Property ❑ Modle Home (IC 61.1-�
mortgagee or contrad seller
Address of mortgagee or contracl seller (number and street, cij�state, ZIP
Name of assignee or other oWner or holder ot mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? I What Taxin��^� �
countyin Indiana? � A Ll.-S"S m
Deduction approved in lhe amount
20 �i"L � 20 b G I 20
P
� �
y�A�ti � ���
m ���� a��
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County Auditar
20
Has this dedudion been requested on
property for current year? � Yes ❑ No
20
Date
20
We certify under the penalty of peryury thal lhe above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owne/s full name)
Y1�t�0 /l�r i
�nt address of applicant
'�T� /Rnr�liG i,,�
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
aulhorized person