HomeMy WebLinkAboutMortgage_Fithian2 STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS �
' FOR DEDUCTION FROM ASSESSED VALUATION � Coun
S / State Form 43709 (R4 / 70-Ot)
i«.
� PresuibeA by DepaM�ent W Laal Govemment Finance p R 1�
INSTRUCTIONS: G `--�5. �.
To be filed in person or by mail with the County Auditor of the county whe2 the propeR�is-!om}ed COUt� � � �`U�'�� � Ury '
Filing Dates: 1) Real PropeRy: During the 12 months be%re May 11 0/ the year the deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 0( the year the deduction is to be eHective.
See reverse side (or additional instructions and aualifications.
Applicant (o or contracf bu r- see nctions on vErse side) „ Q_ __ r_ �c
� � .�[.c.¢�r�ai
Taxing Disirid Key number / legal d scriplion Record number
D � - acx�a - y�F�U
Page number
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owneR ❑ Yes � No
°y 5 Lo Oc� �
If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Rnperty ❑ Mod7e Home QC 61.1-n
�ame of mortgagee or contrad seller
Address of mortgagee or conVact seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, whaf couniy? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current year? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in lhe amount of:
zo Zo Zo zo a G zo �% zo �� zo �
�
Signature��n County Auditor Date
I/ We certify under the penalty of perjury thal the above and foregoing informalion is true and corred and lhat the applicanls was / were
� residenl of Indiana and owner of t e aforementioned properly on March 1, 20 '
Signature (owne ll nam _ Person authorized by duly executed Power of Attomey
j� _� or by IC 6-1.1-12-.07
�
II re ' ent dress af applipnt , Address of authorized person
�d.��� 65.�, oww�s�,i�R,�y7�5