HomeMy WebLinkAboutMortgage_Reedm� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
F FOR DEDUCTION FROM ASSESSED VALUATION
�w� ! Sute Form 43709 (R5/ a-03)
� PrescnDetl by Depanment of Lacal Govemment Finance
INSTRUCTIONS:
Coun Township Year
APR 2 �'���`
To be filed in person or by mail with the CountyAUditor of the county where the property is located. .-
Filing Dates: 1) Real Property: During the 72 months 6elore May 11 o/the year the deduction is to 6e effective. ,od
2) Mobile Homes assessed under IC 6-1.1-7: Between January 75 and March 2 0/ the year`�p�gto be effective.
See reverse side for additional instructions and qualifications. , G�gSON COUNTY AUDITOR
Applicant (owne� or cont�act buyer - see restrictions on reverse side)
. �
Taxing Distrid Key number / legal description Record number
�
�O Pagenumber �q a�
Assessed value of real prop y as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? �s ❑ No
If no, what is his / her exact share of interest? if owned with someone other than spouse, indicate with whom.
If name on record is different than fhat of applicant, indicate below: Is the property in question:
� eal Property p Mobile Hwne (IC 61.1-n
me of mortgagee or contract seller
Add ss of mortgagee or contrad s r(number and sVeet, city, state, ZIP
Name of assignee or other owner or holder of moAgage
Address of assignee (number and street, city, state, ZIP code) '
Drawer NO..��.`-t..-..��•a 5
Does applicant own property in any other If yes, what county? What Taxing Dist _
county in Indiana?
Card NO. �
.....................
COUNTY AUDITOR
Deduction approved in the amount of:
ZO 20 r] 20 20 � 20 20 20
� p � P
Signature County Auditor Date
� We certify under the penalty of perjury that the above and toregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (ow ers full na Person authorized by duly executed Power of Attorney ��
or by IC 6-1.1-12-.07
ull resi ent address of applicant Address of authorized person
I�R I � o �c '-
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