HomeMy WebLinkAboutMortgage_Boyd�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Yeai
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S J Slate Fortn 43709 (R4 / 76-01)
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� Frescribed by Depariment of Local Govemment Finance
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INSTRUCTIONS: _.F e Mark� �
To be filed in person or by mail with the County Auditor of the county whe2 the property is located.
Filing Dates: 1) Real PropeRy: During the 12 months be%re May 11 01 the year the deduction is to be effective. _..� ��� f �O
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of the year the deduction is to be effec��e.
See reverse side Ior additional instructions and qualificaGons. � � �j
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Applicant (owr
Taxing Dislrict
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con6act
Assessed value of real property as of
March i, current year
If no, what is his / her exact share of interest?
If name on record is different than that
of mortgagee or contrad
Key number
Q/ ��� � � C"-' O Page
VJ —
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LS[1
act indebtedness unpaid as of Is the applicant the sole legal or equitable
year ownef? ❑ Yes ❑ No
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indicate below:
If owned with someone other than spouse, indicate with whom.
of mortgagee or conVact seller (number and street, city, state, ZIP
of assignee or other owner or holder of mortgage
of assignee (num6er and st�eef, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid?
counry in Indiana?
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20
Signature
20 Q(�
County Audftor
�
❑ Real
O Mobile Hmie QC G1.1-�
Has lhis dedudion been requested on
property for wrrent yeaf? � Yes ❑ No
� .�
Date
20
/ We certify under the penalty of perjury thai the above and foregoing infortnation is lrue and corred and that the applicants was / were
� resident of Indiana and owner of the aforemenlioned property on March 1, 20
address
.
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person