HomeMy WebLinkAboutMortgage_FoleySTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
>� «� . ! State Fwrt:43709 (R5/ a-03) . . ,
� PrestriDetl by Depanment of Local Govemment Finance -�
INSTRUCTIONS:
To be fi/ed in person or 6y mail with the County Auditor ol the county where the propeRy is IocateB' 5 2p06
Filing Dates: 1) Real Property: During the 72 months before May 11 0l the year the deduction is to be e e.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year�e deduction is to 6e eflective.
See reverse side for additional insfructions and qua/iTcations. .Jyy�a ,Q�f'`�
µC�NTY AUDITOR
Applicant (ow�o � onfract bu er- rest�ctions on reverse side) •
Taxing Distrid
Assessed vatue of real property as of
March 1, current year
no, what is his / her exact share of inleresl?
descriplion
O I � —� �:
Mortgage / ContraU ir
March 1, current year
Rewrd number�M �
w
— Page number � � y 3
ess unpaid as of Is lhe applicant the sole legal or
owner? ❑ Yes ❑ No
If owned with someone olher than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below:
�me of mortgag or tract seller � �
Address of mortgagee or contraIX seller (number and st2et, c�`state,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, state, ZIP code)
❑ Mobile Home QC 61.1-�
Does applicant own property in any other If yes, what county? What Taxing DistriG?- Has this dedudion been requested on
county in Indiana? property for current year? � Yes 0 No
COUNTYAUDI' Dra�ti,e�, T __
Deduction approved in the amount of: C �, '
Card NO. , ... . ..
20� zo 6�- zo� 2o a� ............... zo
P � ►� �' ���3
Signalure
County Auditor
� We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
residenl of Indiana and owner of the aforementioned property on March 1, 20
full name)
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of applicant �Address of authorized person