HomeMy WebLinkAboutMortgage_Schafer`O R�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' �—�
: FOR DEDUCTION FROM ASSESSED VALUATION Coun Tovinship;;' "Ye ,
�, "/ Slate Fortn 43709 (R4 / 10-01) � �
�'•�• Prescribe0 by Department W Local Govemment Finance M A u
11/if\ i
INSTRUCTIONS: F'le Markl�, /J //
To be filed in person or by mail with the County Auditor o/ the county whe2 the property is located. , J,�'i,c�.� 1/
Filing Dates: 1) Real Property: During the 12 months before May 17 0l the year the deduction is to 6e effectiveSOfJ COUh'T Y qUDITOR �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the year the deduction is to 6e eHective.
See reverse side (or additional instructions and qualifications.
Applicanl (owner or contract ye - e re.�trictions on erse side) �
Taxing Dislrid Key number / legal description Record number Q^
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� � Q � ^., /l //� r // - age number !"� �
(/Vl% /(Y /
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicani 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, indicale with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Horne (IC 61.1-�
" me o( mortgagee or contrad selier
Address of mortgagee or contraIX seller (number and street, ci , state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and stieet, city, sfate, ZIP code)
Dces applipnt own property in any other If yes, whal county? What Taxing Disirict? Has this deduction 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
Signature County Auditor Date
�/ We ceAify under the penalty of perjury that the above and foregoing informalion is true and corred and that the applicants was / were
��esident of Indiana and owner of the aforementioned property on March 1, 20
i nalure (o ners (ull name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
F esid t ddress a ip Address of authorized person
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