HomeMy WebLinkAboutMortgage_Oneal��n 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS •�
,�' FOR DEDUCTION FROM ASSESSED VALUATION C�n sh' Year
j+ SUte Form 43709 (R6! 5-06) -
�� Prescribed by �epartment of Loral Govemment Finance � U N 0 S 2007
INSTRUCTIONS: �TdG. ��; e�`-Ma�
To be filed in person or by mail with the CountyAudifor of the county where the p�operty is locat�BSON COUNTY AUDITOR. .
Filing Dates: 1) Real Property: During the 12 months before ,lune I1 0l the year the deduction is �'o be eKective.
2) Mobile Homes assessed under lC 6-7.1-7: Between January 15 and March 2 o/the year the deducfion is to�6e eflective.
See reverse side !or additional instnictions and quali(ications.
Applicant (o � r nt2c16uyer- see res ctions on reverse side) �
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Taxing Distrid Key num e/ egal description ecord numbgr� �_ 3 3 5�
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a(a - �'"7 -U�/-4u O- Page number
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Assessed value oi real property as of MoAgage / ontrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicale with whom.
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If name on record is difierent ihan that of applicant, indicale below: Is the property in question:
❑ Reai PiopeAy ❑ Mobile Home QC &1.1-�
me of mortgagee ar contrad seller tJ 'i �
Address o( mortgagee or conUact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage '
Address of assignee (number and street, ciry, state, ZIP code)
Does applipnt own property in any other If yes, what wunty? `"'- �n been requested on
county in Indiana? \ 3� �nt yeaf? � Yes ❑ No
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Deduction approved in the amount of: D 1; � ��J -Si
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20 20 �_ 20 �� 20 20 20 20
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Signature County Auditor Dale
�/ We certify under the penalty of peryury that the above and foregoing information is true and corred and thal the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Sig� at� ners (u!1 name� Person authorized by duty executed Power of Attomey
� •—�� or by IC 6-1.1-12-.07
Fu e' ent address of applicant Address of authorized person
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