HomeMy WebLinkAboutMortgage_Lawson.���
a'
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (RS I 4-03)
Prescribed �y Departmem of Local Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor of the county where the property is located. ^1'G Q 1 20��
Filing Dates: 1J Real Property: During the 12 months be%2 May 11 0/ the year the deduction is to be e'fl�ciive. � � � n
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0) th year the deduction is to be eflective.
See reverse side for additional ins[ructions and quali�cafions. J����
G13SON COU'
Applicant(o e rconfractbuyer- eerestrictions reverse�ide
w �- � �
Taxing Distrid Ke umber / legal description Record number
��^ �� � � �y,� Page number � �/�
I�V �LS�� �
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 ownef? ❑ Yes ❑ No
a� o
If no, what is his / her exact share of interest? Ii owned with someone olher than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the propeRy in question:
❑ Real Property ❑ Mobile Hane pC 61.1-�
� e of mortgagee or contreIX seller
Address o( mortgagee or contrad seller (number and treet, city, state, ZIP /�
�v
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code) '
Does applicant own property in any other If yes, what county? What Taxing Distrid? 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
- � �P P P
Signature County Auditor Dale
'/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corcect and that lhe applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20
I� (owners full narpe) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
I r ent address of applicant Address of authorized person
� I /3r,� 4,�'