HomeMy WebLinkAboutMortgage_Leech"`R�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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's' � FOR DEDUCTION FROM ASSESSED.VALUATION
'� _ . � State fpm 43709 (R6 / 5-06) . . .
Resaibed by Department of Local Govemment Finance
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INSTRUCTIONS:
To be filed in person or by mail wdh fhe County Auditor of the county where the property is locafed.
Filing Dates: 1) Real PropeRy: During the. 12 months before ,lune 17 0/ the yea� the deduction is to be elfe�� 2 � Z�� �
2J Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0l the year the deducUon is o 6e e/fective.
See reverse srde Por additional instroctions and qualifications. `�-jj_ _ �,�_
Applicant ( � or contracf buye/r - lsee restrictions on reverse
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Assessed value of real praperty as of
Marctl 1, wrrent year
If no, what is his / her exacl share of interest?
Key number / legal description Record number . a Q O 7
l
oZ�a ��S- o� a2 '/DD - o d� • Page number
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Mortgage / Contred indebtedness unpaid as of Is the applicani the sole legal or
March 1, cuRent year owneR ❑ Yes ❑ No
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name on record is difierent ihan that of applicant,
of mortgagee or contrad seller
If owned with someone other than spouse, indicate with whom.
i �.�c�.-rr�, . � �. o�-7bo
below: --- --_ Js the property in q
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Dra�r�er IYO.v��Q 7.-.. ���
Address of mortgagee or contracl seller (number and street, city, state, ZIP
. ard i\'O. ..
- • ..............
Name ol assignee or other owner or holder oi mortgage �' � � U� p�
,
Address of assignee (number and sUeet, city, state, ZIP code) '
Does appGcant own property in any other If yes, what county? What Taxing Distrid7 Has this dedudion been requesled on
county in Indiana? property for current year? � Yes 0 No
Dedudion approved in the amounl of:
20 �� 20 �_ 20
C V
Signature
COUNTY AUDITOR
20
County Auditor
20
20
Date
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certify under lhe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
(owners
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
res' ent address ot ap i t� //� �� Address of authorized person
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