HomeMy WebLinkAboutMortgage_Mallory�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
: �J Siate Fortn 43709 (RS / 4-03) '
�«• •
� Prescn�ed by Depanmeni of Local Govemment Finance
INSTRUCTIONS:
To be (iled in person or by mail with the County Auditor o! the county where the propeRy is located. �� � � U 8 2004
Filing Dates: 1J Real Property: During the 12 months 6efore May 11 of the year the deduction is t ef(ective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of t�ear t e d u is to be eNective.
See reverse side for additional instructions and qualifications. '/ G 6S���T7��
�-� 1' AUDf70R
Applicant (owner
Taxing Distrid
�� / / t.�'V/v�
Assessed value oi real
March t, current year
as of
no, what is his / her exact share of interest?
on
/ legal description
v pD� -000s9
Record
number
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owneR ❑ Yes ❑ No
� � V `�
owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
mortgagee or contreIX seller
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and street, city, state, ZIP
Does applicant own property in any other If y
counry in Indiana?
Deduction approved in lhe amounf of:
20
Signature
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q���� .
L�''Grl �
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04 -7932
20 � I 20 � I 20 � 20
County Auditor
propeAy in question:
❑ Real Property � Mobile Horne (IC 61.1-�
Has this deduction been requested on
property for wrrent year?� Yes❑ No
20
Date
20
certify under the penalty of peryury that the above and foregoing information is true and correct and that the applicants was / were
lenl of Indiana and owner of the aforemenlioned property on March 1, 20
name)
N,
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person
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