HomeMy WebLinkAboutMortgage_HuntSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
\ / Sfate Fotm 43709 (R3 / 10-00)
_� Prasaibed M State Board of Tax Comrttissioners �
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 morrths before May 11 of the year the dedudion is to be effedive. See
reverse side for additional insWdions and qualifications.
FORM 5
����
��'�
:� -.
OCT �"�p�
�G�B�TY AUDITOR
ApplipM (owneror ntract buyer- see 2stri on reverse side) � •
, .
Taxing Distrid Key number / legal desaiption Record number
� � QD ��_(ti, Page number D`
� li�J
Assessed vatue of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole leg I or equitable
March 1, wrtent year March 1, wrrent year owneR ❑ Yes ❑ No
d .
If no, what is his / her exact share of interesi? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indiwte below:
of mortgagee or contrad seller �
Address of mortgagee or conVad seller (number and st2et, city, state, ZIP .
�
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, aty, state, ZIP code)
Does applicant own real property in any If yes, what counry? What Tauing DisUid? Has this dedudion been requested on
other county in Indiana? property (or wrrent yeaR ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
e �'
zo 4a 1�� zo � zo so �. zo zo _� zo c' c� �
� �� �d3t�TkP�d IM��" � � �
Signature County Auditor Date
''Ne certify under the penalty of perjury that the above and foregoing infortnatlon is We and corred and thal the applicants was / were
ident of Indiana and owner of the aforemenGoned property on March 1, 20
gna r, (owners I nam ) Person authorized by duly executed Power of Attomey
or by IC 61.1-12-.07
Fu i ent address of applicant Address of author¢ed person
.�