HomeMy WebLinkAboutMortgage_Pegram (4)i` �R� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i'�= FOR DEDUCTION FROM ASSESSED VALUATION Co Tow Year
�+ State Fortn 43709 (R6 / 5-06) - � 1
� M Presaibed by Department of Local Govemment Finance
INSTRUCTIONS: File Maric
To be filed in person or by mail with the County Auditor o/ the county where the propeRy is located. �Ja<., ,Gl� �
Filing Dates: 1J Real P�operty: During the 12 months before June Il of the year lhe deduction is to be ef(ective. Q Q
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yea��� dei�tic�%i� isyt�b����fl�ctive.
See reverse side for additional instiuctions and quali�cations.
Appli�t (owner or col
Taxing Distrid
A�sed val e real
March t, current year
buyer- see 2striq£iqns on reverse side)
Key nur�5per / legal
Record number
� �
c{lo-I"1-o3-yoo-�3.-Ilrj-aa � ragenumoer � g /
�O
as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year ' owneR � Yes ❑ No
If no, what is his / her exad share of interes[?
If name on record is dif(erent than ihat of applicanl, indicate below:
moRgagee or contrad
0
If owned with someone other than spouse, indicate with whom.
Address ot mortgagee or contrad seller (ntimber and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(number and streef, city, state, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing Distrid?
munty in Indiana?
1�" cJF 3'3 _ 1 a 1. ag � o„COUNTY AUDITOR
Deduction appro��ed in thz amounf of:
2° °P I z°�
d
Signature
20 � 2�
County Auditor
20
Real Properly ❑ Mobile Home (IC 61.
Has this dedudion been requested on
property for wrrent year? � Yes ❑ No
20
3�]
We certify under the penalty of perjury that the above and foregoing information is lrue and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
natur@{owners full name) Person authorized by duty executed Power of Attomey
�m.. Y�,.,. ,. .,�n � or by IC 6-1.1-12-.07
Full resi�ent address of applicant
�
person