HomeMy WebLinkAboutMortgage_Miller (6)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
S � State Fofm 43709 (R4 / 70-01)
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Prescribed by Departmenl d Local Govemment Finance
INSTRUCTIONS: Fiie Mark r � ==�
To be filed in person or by mail with the County Auditor of the county whe2 the property is /ocated. � L � 1 0 Z002
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to 6e effective.
2) Mobile Homes assessed under IC 61.1-7: Between January 15 and March 31 0/ the year the deduction is to be e¢tive.
See reverse side /or additional insWcfions and qualifica6ons. •��-t �_= � f 7�. ,
.:=`?�� i%`Ji�N"r AUDITOR
(owner
Taxing District
� \ U �
see
Assessed value of real property as of
March 1, curtent year
side)
Key nulf�ber / legal
Record number j1 �
LJ
� � ^� f \ Page number � r7
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MoRgage / ConVad indebtedness unpaid as of Is the applipnt the sole legal or
March 1, wrrent �ear owneft ❑ Yes ❑ No
I( no, what is his / her exact share of interest?
If name o� record is different Ihan that of applicanl, indicate below:
mortgagee or contrad seller
Address of mortgagee or contracl seller (number and street, aty,
Name of assignee or olher owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Dces applicant own property in any other If yes, what county7
county in Indiana?
Deduction approved in the amount of:
20
Signature
20
� O
If owned with sameone other than spouse, indicate wilh whom.
s the property in question:
❑ Real Pmperty ❑ Mobile Home
What Taxing District? Has this deduction been requesled on
property for current year? � Yes � No
COUNTY AUDITOR
20 � I 20 �
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U
County Auddor
zo 0 7 � 20
Date
zo �
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We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and lhat lhe applicants was / were
resident of Indiana and owner of lhe aforemenlioned property on March 1, 20
(owners full n�me) _ _ ,
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of applic�nt � �Address of authorized pereon