HomeMy WebLinkAboutMortgage_Hamilton'j�m� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
�FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
State Fwm 43709 (RS / a-03) � ,
� Pfescnbed by Department al Lotal Govemment Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor o( the county whe2 the property is located. �'�^� �� r. <� \
Filing Dates: 1) Real Property: Dunng fhe 12 months before May 11 0l tbe year the deduciion is to be•eY/echve.� r{� ' �} }
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the-year th�e_deduction� s to be e ective.
See reverse side for additional instructions and qualifications.
OCT �? �nna
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Applicant(ownerorc nt buyer- e res 'ct' n verseside (( � � /J U,� /�
if-U ..�-�7J,• a� " %
�' ;SGN COU�ti�TY �ii�,�rr�'�'
Taxing;�D,is/triyf Key nu ber / legal description Record number
��' / ����2' "' "� V O/—O� Tv�� Page number a�
Assessed value of real roperty as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, wr�ear owner? ❑ Yes � No
if no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
tf name on record is different lhan lhat of applicant, indicate below: Is the property in question:
❑ Real Properry ❑ Mobile Horne pC Cr1.1-�
��ne of mortgagee or contract seller
Address ot moAgagee or contract seller (number an et, city, state, ZIP �
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st�eef, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 �_ 20 �_ 20 20 20
� `
Signature County Auditor Date
�� We certify under lhe penalty of perjury lhat the above and foregoing information is true and corred and thal ihe applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
' nature ( ers full.�am Person authorized by duty executed Power of Attomey
/ _ or by IC 6-1.1-12-.07
II resident address of a licant Address of aulhorized person
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