HomeMy WebLinkAboutMortgage_Simpson (2).e� "`R,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
t FOR DEDUCTION FROM ASSESSED VALUATION t ip� Year
� State Fortn 43709 (R6 / 5-06) � O O
� Presaibed by Deperimem of Lonl Govemmerri Finance C / p
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INSTRUCTIONS: Fiie Mark
To be filed in person or by mail with the County Auditor of the county where the propeRy is located. � ��6"'
Filing Dates: 1) Real Property: Du�ng the 12 months before ,lune � 1 0( lhe year lhe deduction is to b t� ���. �diTqo
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 0/ thc����e educSon is to be effective.
See reverse side /or additional ins6ucUons and qualifications.
Appli nt (o � or ntract uyerr see ctions on reverse si ) .
�
Tauing Dist d Key number / legal des t n Record number
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/� �/� u„i n�� .- l/ l/- 1 n/ �% f�/7� .(fU Page number /„ �a
l�! u� v�vJ t �!� �. ��J ! �,(J � �D
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, currenl year owne(? � Yes ❑ No
���� '.
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diflerent than that of applicant, indicate below: ' Is the property in question:
' ---- -_ _f_l Real Pruperty ❑ Mobile Hortie QC 6�1.1-�
�me of mortgagee or contrad seller � L
�� �� Q � / 7
Address of moRgagee or contrad seller (number nd stieet, city, state, ZIP —,S`_ (CJ 2
Name of assignee or other owner or holder of mortgage a,,,s� °�°• `b
/ L+..r„�(..
Address of assignee (number and sheet, ciry, state, ZIP code) °— �'�^'
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has fhis dedudion been requested on
counfy in Indiana? properiy (or wrrent year? Q YesO No
COUNTY AUDITOR
Dedudion approved in the amounf of:
20 O' 20�� 20 O�_ 20 20 20 20
/
Signature County Auditor Date
/ We certify under the penalty of perjury that lhe above and foregoing intormation is true and corred and lhat ihe applicants was / were
a resident ot Indiana and owner of the aforementioned property on March 1, 20
Signature (owners Iull name) Person authorized by duly executed Power of Attomey
' or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person
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