HomeMy WebLinkAboutMortgage_BaneSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION
� � State Fortn 43709 (R4 f 1P-01)
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Year
�P�escnbe0 M DeDaNrent W Loral Govemment Fu�an � I I
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INSTRUCTIONS: � �j � File �1arKJ
To be filed in person or by mail with the County Auditor oI the county where the property is lo ed. g ��
Frling Dates: 1) Real Property: During the 12 months be%�e May 11 0/ the year the deduction is to f.j��fer���^�
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0l the�le�r ifl i� n is to be eHective.
See reverse side (or additional instructions and qualifica6ons. ,
(owner
Taxing
/
buyer- see resMc6ons
Key number / legal description
C� —�"� -/ bd S�� d a� Page number ���
IU {�
Assessed value oi real pro rty as of Mortgage / Contrad indebtedness unpaid as ot Is the applicant the sole legal or equitable
March t, current year March 1, c�af year ownef? � ❑ Yes ❑ No
���7 4- -O
If no, what is his / her exacl share of interest? If owned with someone other tha pouse, mdicate with whom.
If name on record is different than that oi applicant, indicate below: Is the property in question:
of mortgagee or contrad seller
Address of mortgagee or conVact seller (number
Name of assignee or other owner or holder of mortgage
aty, state, ZIP
Address of assignee (number and st2et, city, sfate, ZIP code)
Does applicant own property in any other I If yes, what county? What Taxing DistriIX?
caunty in Indiana?
Dedudion approved in the amount of:
20
Signature
20
COUNTY AUDITOR
20 20 20
County Auditor
❑ Real Property ❑ Mobite Home pC 61.
Has this dedudion been requested on
property for curcent yeaRO Yes� No
20 ()�5 20�
P P
Date
/ We certify under the penalty of peryury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person aulhorized by duly executed Power ot Attomey
or by IC 6-1.1-12-.07
address of applipnt �Address of authorized person