HomeMy WebLinkAboutMortgage_Jones (2)�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-° ' FOR DEDUCTION FROM ASSESSED VALUATION Co Ta rashi Year
� / Sfate Fortn 43709 (R4 ! 10-07)
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PrescribeA by Depanmenl af Laal Govemment Finance
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INSTRUCTIONS: File rk
To be filed in person or by mail with the County Auditor of the county whe2 the propeRy is located.
Filing Dates: 1) Real PropeRy: During the 12 monfhs belore May 11 of the year the deduction is to ��DT
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the }�$ ibX �'s-to�be eflective.
See reverse side for additional instructions and qualifications.
Appli (o er or contract buyer e restdc6ons on reverse side)
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Taxin Disirict Key number / legal description Record number aO �
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Assessed value of re roperty as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interesi? 0/ If owned with someone other than spouse, indicate with whom.
If name on record is diBerent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
me of moRgagee or contract seller
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Address of mortgagee or contrad seller (number and st2e ci , state, ZIP O
Name of assignee or other owner or holder of mortgage /
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Address of assignee (num6erand street, city, state, ZIP code)
Ooes applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curtent yeaR 0 Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 20 20 20 20 20 � 20 0�_
�a,�°`' � P �P P
Signature County Auditor Date
' We certify under the penalty of peryury lhat the above and foregoing infortnation is true and correct and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Si ature (owners lull mej� Person authorized by duly executed Power of Attomey
�' or by IC 6-1.1-12-.07
F II resi ent address appl' t Address of authorized person
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