HomeMy WebLinkAboutMortgage_Short (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' ' FOR DEDUCTION FROM ASSESSED VALUATION T Coun Township Year
S M�� / SUte Form 43709 (Ra / 10-0t ) fl , ' � (; ? �
PrescribeC by DepaNrent of Local Govemmen[ Finance y�y 3LJ
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INSTRUCTIONS: FTe KifBrk
To 6e filed in person or 6y mail with fhe County Auditor of the county where the property is locat�' /
Filing Dates: 1 J Real Property: Dunng the 12 monfhs 6e%re May 11 of the year the deduction is o be effeeti�le. �
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2) Mo6ile Homes assessed under IC 61.1-7: Between January 15 and March 31,o�eLyear t4e de ucf�o �S-!� effective.
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See reverse side for additional instructions and qualifications.
Applicant (owner or contra b - see rest ' ns n reve s side) �
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Taxing Distri Key number / legal description Record num O
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/� �� Page number
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Assessed value of real properly as of Mortgage / Contrad indebtedness unpaid as of Is the appticant the sole legal or equitable
March t, curtent year March 1, current year ownef? Q�Yes ❑ No
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Ii no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanl, indicate below: Is the operty in question:
�Property ❑ Mobile Hmie (IC 61.1-n
�ame of mortgagee or ntrad seller /7 �
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Address ot moRgagee or conVad seller (number nd sfree , city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
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Signature County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing informalion is true and corted and that the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
a owners full name) Person authorized by duly execufed Power of Attomey
or by IC 6-1.1-12-.07
Full resident add ess of appliqnt Address of authorized person
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