HomeMy WebLinkAboutMortgage_Schuleyi.�"�� } STATEMENT OF MORTGAGE OR CONTRACT INDEB"s"EDNESS
`+ �r FOR DEDUCTION FROM ASSESSED VALUATION . ,
J State Fortn 43709 (R6l 5-06)
�� Presoibed by Department af Local Gwemment Finance
INSTRUCTIONS:
To be Crled in person�o� 6y mail with the CountyAuditor o1 the county where the p�operty is located. �UN � 1 Z���
Fifing Dates: 1) Real Property: Dunng the 12 months belore ,lune 11 0( the year the deduction is to be effectiv .
2) Mobile Homes assessed unde� IC 6-7. 7-7: Between January 15 and March 2 0/ the yea� the deduction is to be elfective.
See reverse side /or additional instnictions and quali(ications. �d� �
oisson eauntr r.�g��eR
or contract(4uyer - see restrictions on
Distrid
Assessed value of reai property as of
March 1, current year
no, what is his / her exad share of interest?
Key number / legal descrip4i6n V Record number
oas- 04?J6� ��
^� ^ � _ � Page number
.(
MoAgage / Contract indebtedness•unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes ❑ No
If name on record is different than lhat of appiicant, indicate below:
mortgagee or contract seller
If owned with someone other lhan spouse, indicate with whom.
Address of mortgagee or contrad seller (number and streef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any ofher I If yes, what county?
county in Indiana?
Deduction appro� ed in the amounl
20 0� � 20 fJ jL
P
Signature
Is the property in queslion:
❑ Real Property ❑ Mobile Home (IC 61.
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�at�duJC.��+ � „_° �'°^`Q.�hc.
Dra�vcr NO.... ( CXD........
Whal Tax�. I y�c� ) „
CaCd \�. ... ... �.?CSI .��..
: '�l0'� � $�•
COUNTY AUDITOR
20 �i 20 20
County Auditor
20
20
on
7No
We certify under the penalry of perjury that the above and foregoing information is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
Person authorized by duty executed
or by IC 6-1.1-72-.07
person