HomeMy WebLinkAboutMortgage_SobotkaSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S µ� � State Form 43709 (R5 / 4-03) � � �}� : A
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Prescrin�ed by Departmem o1 Loral Govemment Financa �LJ
�i,vsrRUCr�on,s: MA�ile Ma�004
To be filed in person or 6y mail with the County Auditor o( the county whe2 the property is located. �
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to be e ctive. �I � �
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the yea de�c(ion-�s'_'to�8e"�
i5S c.�;t. a � �����I
See reverse side for additional insfructions and qualifications.
(ownerorcontract 6uyer- see restrictions on reverse side)
Taxing
�
Assessed value of real property as of
March t, curcent year
If no, what is his / her exad share of interest?
If name on rewrd is different than that
of mortgagee or contract s
n .
Key number / legal description
v � � - vv
Mortgage / Contrad ir
March 1, current year
indicate below:
Record number
Page number
unpaid as of Is the applicant the sole legal or equitable
owne(? �s ❑ No
J c- ,. 1
If owned with someone olher lhan spouse, indicate with whom.
Address of mortgagee � contracl seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant own property in any olher I If yes, what county?
county in Indiana?
Deduction approved in the amount of:
�
Signature
cou�
Is the property
o�
Drawer NO...�.� -...3
Card NO . .......:............
20 p�_ 20 Z 20 0�
`i ,� a
County Auditor
t
20u1�- '�"� A 20
. '1
� Mobile Home (IC 61.1
;tion been requested on
rrent yeaf? � Yes � No
20
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
'resident of Indiana and owner of the aforementioned pt�perty on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
person