HomeMy WebLinkAboutMortgage_Richardson�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
+,'" .° FOR DEDUCTION FROM ASSESSED VALUATION � �unt Township . Year
'�, �y Slale Form 43709 (R4 / 10.01) (�.. °
PrescnEeO by DepaMenl ot Local Govemmeni Finance ��
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OCT 3 0 2002
INSTRUCTIONS: File Mark
To be filed in person or by mail with fhe County Auditor of the county where the prope is located.
Filing Dates: 1) Real P�operty: During the 12 months before May 11 0/ lhe year the Gcfion-is���r.tivg�
2) Mo6ile Homes assessed underlC 6-1.1-7: Behveen January 15 and Mai�h'�33�oRfie�'y'ear the:deduc on is to be eflective.
See reverse side for additional instructions and quali�cations.
Applicant wner or confrac`t bu-y see restrictions on r rse side) �
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Taxing Distnd Key number / legal description Record number
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Assessed value of real prop y as of MoRgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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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 ihat of applicant, indicate below: is the property in question:
❑ Real Pmperty ❑ Mobile Home (IC &1.1-�
�me of moAgagee or contrad seller
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Address of moAgagee or contrad selier (number and st�eet, city, state, ZIP
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 wrrent year? Q Yes ❑ No
� � , _ 1 '1 COUNTY AUDITOR
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Deduction approved in the amounl of:
20 20 20 20 20 9� 20 �' 20 �_
.�-9,-0�' P P P
Signature County Auditor Date
I We certify under lhe penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of ihe aforementioned property on March 1, 20 �
S a�re (owners full nam )• Person authurized by duly executed Power of Attomey
� L � or by IC 6-t.t-12-.07
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ull resibent address o applicant Address of authorized person
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