HomeMy WebLinkAboutMortgage_Neufelder� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Townshi Year
�' � «� ! State Fortn 43709 (R5/ 4-03) '
� PrescriDed by Department of Loral Govemment Finance
NOV 12 2�04
INSTRUCTIONS: File Ma
To be filed in person or by mail with the County Auditor o! the county where the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to be t'v .
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the y r�gg�� � �oFb.�E i8ti e.
See reverse side Ior additional instructions and
Applicant
Taxing
6uyer- see r�n'ctioPs on
Key number / legal
Record number
Q //� CJ /
� �� —��� p— U v Page number ���
Asse ed valu f real prop rt as of MoRgage / Conlrad indebtedness unpaid as of Is the applicant the soie legal or equitable
March 1, wrren year March 1, current year ownef? ❑ Yes ❑ No
� 011d
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan ihat of applicant, indicate below: Is the property in question:
of mortgagee or contract seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortoa�o_ � - --
Address of assignee (number and street, city, s DrawC1' �T �...Q •� �• •�`3 9�
Does applipnt own property in any other If yes; "—
county in Indiana? Card NO . .....................
Deduction approved
20 D /r,
Signature
the amounl of:
20 �
.....,ni � r�uullUR
20 D � 20 �� 20
County Auditor
❑ Real Properry ❑ Mobile Home (IC 61.1-
Has this deduction been requested on
property for current year? �] Yes 0 No
20
�
certify under lhe penalty of perjury that the above and foregoing information is true and corred and lhal ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-7.1-12-.07
Address of authorized person