HomeMy WebLinkAboutMortgage_Andersonrt�'�' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i*-° �: FOR DEDUCTION FROM ASSESSED VALUATION C n w s `Year
4 �J S�ate Fortn 43709 (R4 ! 7P07)
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�� PrescribeA Dy DeDartment of Local Govemmem Finance
INSTRUCTIONS: � Mark
To be filed in person or by mail wifh the County Audifor of the counfy where the property is loca
Filing Dates: f) Real P�operty: During the 12 months be%re May 11 01 the year the deduction i o�Ll8R8CG}.@U T Y AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0( the year the deduclion is to be eflective.
See reverse side (or additional instructions and quali�cations.
Applicant (owne� or contract q�r - see restrictions on rever side)
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Tauing Distrid Key number / legal description Record number O
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Assessed value of real property as of MoAgage / Contract indebtedness unpaid as of Is the applicant the sole e or equitable
March 1, current year March 1, current year owner? ❑ Yes � No
as
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat ot appiicant, indicate below: Is the property in question:
O Real PropeAy O Mobile Home (IC fr1.1-�
��e of mortgagee or contreIX seller �� �
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
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Si alurev CountyAuditor Date
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��N certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
, ident of Indiana and owner of the aforementioned property on March 1, 20
' ature ers full nam Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
ull si ent addre of applicant �( Address of authorized person ��
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