HomeMy WebLinkAboutMortgage_PennerSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
` �� State Form 43709 (R4/ 10-07) � � l
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Prescribe0 by Department ot Loca� Govemment Finance ;� �`
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INSTRUCTIONS: Ar����.��P003
To be filed in person or by mail with the County Auditor oI the county wheie the property is located.
Filing Dafes: 1 J Real Property: During the 12 months belo�e May 11 of the year fhe deducUon is to be eff ctive. ��
2) Mobile Homes assessed under IC Sf.l-7: Behveen January 15 and March 31 0/ the y a� ther/eductioaisto be eN�ecybve.
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See 2verse side !or additional instructions and qualifications.
Applicant (owner or contract bu r- se restrictio s on reverse d
Taxing Distrid Key number / legal description Record number �
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Auessed value of I property as f Mortgage / Contred indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If awned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below: Is lhe property in question:
❑ Real Property ❑ Mobile Horrie pC 61.1-�
�ame of mortgagee or contraIX seller
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Address o( mortgagee or wntrad seller (numbe and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
counfy in Indiana? property for current yeaR � Yes 0 No
COUNTY AUDITOR
Deduction approved in the amount of:
20 _Q�_ 20 20 Q(�_ 20 �� 20 _L1 � 20 � 20
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Signature Counry AudRor Date
�I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
S ture wners /ull na Person authorized by duly executed Power of Attomey
� ' or by IC 6-1.1-12-.07
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F Ii ent address of applipnt Address of authorized person
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