HomeMy WebLinkAboutMortgage_Davis (2)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
'� Sta!e Form 43709 (R5 / 4-03) Q�j �
� ,«•
PresaiCed by Department o( Lopl Govemment Finance Q
iNSrRUCnoNS: �AN 1 �;'f�d�*
To 6e filed in person or by mail with the CountyAUditor of the counry whe2 the property is located.
Filing Dates: 1) Real Property: During the 12 months before May 11 ot the year fhe deduction is to be effective.
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year��uQ fo be effective.
See reverse side lor additional inshuctions and qual�cations. p�g�BN 68Ut��i' A_6��Q�
Applicant owne�orcontractb er-seerestrictions n verseside)
, � J .
Taui istrid Key mber / legal description Record number ��
Q � �� ' �9� �� O/� _ry1 Page number �����
�.v
Assessed value eal property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ��y a� owneR ❑ Yes ❑ No
�� 0
O ��
ii no, what is his / her exacl 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 Horrie (IC 61.1-�
�me of mortgagee or contract seller
�
Address of moRgagee or cont�ad selier (num r and street, city, state,
Name of assignee or other owner or holder of mortgage D ra���er N�.. �llv.^t• .l ••••.•••
Address of assignee (number and street, city, state, ZIP code) ��( �7 pG
Card NO. ... y �.7�........
�T � 11 O ✓O
Does applicant own property in any other If yes, what county? Wna� i axmg uiscna � ��a� ����� _���,��� � �..an requested on
county in Indiana? property for current year?0 Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounl of: .
20 �_ 20 � 20 �_ 20 20 20 20
P � P
Signature County Auditor Dale
We certify under the penalty of perjury thai the above and foregoing information is lrue and corred and lhat the applicants was / were
residenl of Indiana and owner of the aforemenlioned property on March t, 20
Signature ( ners /pl( name) Person authorized by duly executed Power of Attomey
( I � dJ 1 or by IC 6-1.1-12-.07
uil esidenl address oi applipnt Address of authorized person
�R � �3 Fra��,s v