HomeMy WebLinkAboutMortgage_Collins (16)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�. ! Stata Fwm 43709 (RS / 4-03) . � '
�.
� PresdiDed Ey Department ol Lotal Govemment Finance �
lNSTRUCTIONS: File Mark
To be filed in person or by mail with ihe County Auditor of the county where the property is located.
Filing Dates: 1J Real Property: During the 12 months 6efore May 11 of the year the deduction is e �ve.
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 of�e�t ded�n i to eNective.
See reverse side for additional instructions and qualifrcations. �'�
(owner or confract
�
see
Assessed value of re`al property as of
March 1, alnent year
side)
number / legal description
-00��3 �C7
MoAgage / ContraU indebtedness
March 1, curtenl year
JAN 2 7 2006
Page number "17 .n� �
o(
as of Is the applicant the sole legal or
owner? � Yes ❑ No
If no, what is.his / her exad share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
� � ❑ Real Property ❑ Mobile Horne Q(
'me of mortgagee or conUad seller
Address of mortgagee or conVact seller (number and st e city, state, ZIP •
� Name of assignee ocnthar ��_...•.�,�i.+�• ..f moRgage
�0..��.......
Dra��'er i
a�s
Card NO.�.�q' �p. dty..
�� �J �"'
Deduction approved in lhe amounl of:
20 O 20 �_ 20
�
Signature
state, ZIP code)
s, what county? What Taxing District? Has this deduclion been requested on
property for wrrent yeaR �] Yes � No
COUNTY AUDITOR
20
County Auditor
20
20
�
We ceAify under ihe penalty of perjury that the above and foregoing information is true and correct and lhal the applicants was / were
'esidenfot�lndiana and owner of the aforementioned property on March 1, 20
rivner's full na e)
t ad s o( aoolica�,
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person