HomeMy WebLinkAboutMortgage_Russella��A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
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�+ State Fortn 43709 (R6 / 5-06)
� Presaibed by Department of Laal Govemment Finance
INSTRUCTIONS:
To be filed in pe�son or by mail wrth the County Auditor o/ the county where the p�opeRy is located.
Filing Dates: 1) Real Property: During the 12 months 6efore ,lune �l ol the year lhe deduction is to be eflective.
2J Mobile Homes assessed unde� IC 6-1.1-7: Behveen January 15 and March 2 of the year the deduction is to be eflective.
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See reverse side fo� additional instnictions and qual�cations.
cont2ctbuyer-see
Taxing
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Assessed value oi real property as of
March 1, current year
If no, what is his / her exad share of interest?
Key
� Io'II-17��/OG -C2� , Pagenumber �
Mortgage / Contrad indebtedness unpaid as of Is e applipnt the sole legal or e
March 1, cunent year owne(? � Yes ❑ No
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If owned wi�h someone other lhan spouse, indicate wilh whom.
If name on record is different than that of applicant, indicate below:
e of mortgagee or conV seller�
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Address of mortgagee or contr selier (number and street, 'ty, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and sUeet, city, state, ZIP
Dces applicant own property in any other If yes, what county?
county in Indiana?
approved in the amount of:
20 �
�
Signature
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Is the property
� Mobile Hortie (IC 61.
� � .�.:
� 9a, SC�. _ . �I-� . i
Dra��•er NO....`.�.�./.......
,� C��a�d NO. .....�.�' r.�2� �.�..^, ,�,Z..
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COUNTY AUDITOR
20
County Auditor
�
20
Date
20
ested on
fes� No
certiTy under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Full re$Q�nt address of
�
Person aulhorized by duty execuled Power of Attomey
or by IC G1.1-12-.07 ,
of authorized person