HomeMy WebLinkAboutMortgage_HurtSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
\ � Spte Fortn 43709 (R3 / 10-00)
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t�PresenbeC by State Boartl of Tax Cortvni55ioners
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Instructionsforfiling:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 moMhs before May 11 of the year the deduction is to be effective. See
reverse side for additional instructions and qualifications.
FORM 5
OCT 1�0 2001
G�B/�v'TY HUDITOR
Applicant (owner or co tract buyer- see 2stnctions on reverse side)
Taxing DistriG ey number / legal desaiption Record number 1
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1; current year March 1, current year owneR ❑ Yes ❑ No
3
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate vrith whom.
If name on record is different than that of appiicant, indicate below:
�� of mortgagee or contrad seller
Address of mortgagee or conVad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, dty, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing District? Has this dedudion been requested on
other county in Indiana? properiy for current yeaR ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount af:
so E1. �-1 2o Q� zo 2o zo d CD 2o fJ � 20 o f
S t DA � `� i
Sig ture b� County Auditor Date
�� e certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Si nature wners full name) Persan authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
Fuil esi nt address o apA�p�x ¢9 j• Address of author¢ed person
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