HomeMy WebLinkAboutMortgage_Fears (2)!°i�� 1 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' FOR DEDUCTION FROM ASSESSED VALUATION � n Year
'�. . N� / SUte Form 43709 (R6 / 5-06) � '
� Rescnbed by Oepartment of Local Govemment Finance
DEI,
INSTRUCTIONS: File Mark
To 6e filed in person or by mail with the County Auditor ot the county whe�e the p�opeRv is located. 41ja� ,Q/.�a.
Filing Dates: 1) Real Property: Dunng the 12 months before June 11 of the year the deduction is to be effective.0 ��pT
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the �filA� ��o� �s�to�be elfective.
See reverse side lor additional instructions and quali/rcations.
Applicant (owner or contrayct 6_uy/er- see restridions on reverse si�
o(• �"
Taxing Distrid Key number / legal description Record number
�92cr�Ky�� ava �
a6.p�_�j7_��S QD07 Pagenumber ��8�
O
Assessed value of real 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 ' owneR ❑ Yes ❑ No
lJ' 000
If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: �J 7�O +
Dra���er NO..°,.�.��•r•..... • i-�
�e of martgagee or contract seller �p � ��-O
UL� / w"�- ............�C
. . Card NO. .......
Address ot mortgagee or contract seller (number and street, city, state, ZIP Q,/ //1 �/3 y S�VQ�
/V �U �
. �
Name of assignee or other owner or.holder of mortgage
,'og` s
Address of assignee (num6er and st2et, city, state, ZIP code) '
Does appliqnt own property in any olher If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curtent yeaR � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 _� 20 20 20 20 20 20
� P
SigRature County Auditor Date
We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was ! were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (o ners ll name) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
ul resident addr s af applicant Address of authorized person
.�y9 �. 5R 5(� �JaZI'�'��✓� ��J ��40