HomeMy WebLinkAboutMortgage_Peach�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
�w� .� Stete Form 43709 (R5 / 4-03)
�� PrescnDed by Depanmem o/ Local Govemment Finance
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INSTRUCTIONS: '�-/�a �6'�Mark
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To be filed in person or 6y mail with the County Auditor o( the county where the property is located. �
Filing Dates: 1) Real Property: During the 72 months be%re May 11 0! the year the deduction is �d��t�Q��NTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of the year the deduction is to be eHective.
See 2verse side for additional insfiuctions and quali�cations.
(avnerorcontracf6uyer-see
Taxing
oa5-�y I �S- �
Assessed value ofrealproperty as of
March 1, current year
If no, what is his ! her exact share of interest?
If name on record
on reverse
number / legal
Record number�� �
ra'
Page number
Mortgage / Contrad indebtedness unpaid as of
March 1, current year
than that of applicant, indicate below:
mortgagee or contrad seller
Is the applicant tF�sole legal or equitable
owner? � ��es ❑ No
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contiact seller (number and street, city, stafe, ZIP
Plame of assignee or olher owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
property
❑ Mobite Horz�e (IC 61.1-�
Does applicaN own property in any olher If yes, what county? / �' Has this deducti
county in Indiana? 6�` ���� • ��
' Drawer Np '
� �3� 000.ao ........... ......
cour Card 1�rp. ,2aes.
Deduction approved in the amouni of: � � � � � "' • • • • ��0. �� .
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2� �7 2� _Q� Z�
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Signature
20 I 20
County Auditor
Date
�n been requested on
-" •^��?�Yes❑No
20
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of A�tomey
or by IC 6-1.1-12-.07
of applicant ,r _ �Address of authorized person