HomeMy WebLinkAboutMortgage_Wallace� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
1� w� J Siate Form 43709 (RS / 4-03)
� Presuibed by Department of Lora� Guvemment Finance
INSTRUCTIONS: � -.r �,File Mark� �
To be filed in person or by mail with the CountyAUditor ol the county whe2 the property is located. � �� F1 �
Filing Dates: 1) Real Property: During fhe 12 months belore May i 1 0l the year the deduction is fo be e/fecti�e. �J
2J Mo6ile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to be ef/ecfive.
See reverse side for additional insbuctions and qualifications. �U � 1 � Z��3
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Applicant (owner or co ra buyer - see restn on rqver ide) �-,��YJ%=-��`^-""�
\� ..� �M ':�' R�T Y A�DITC;, �
Taxing D� Key number / legal escriplion Record number
/n� �/ � � 'O� Page number �7/
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, curtent year March 1�rrent year ownef? ❑ Yes ❑ No
9100
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 differenl lhan lhat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contracl seller ,//�
/ �
l. �
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
- 7
Address of assignee (numberand sheet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for currenl yeaf?� Yes❑ No
COUNTY AUDITOR
Deduction approved in fhe amount of:
20 20 20 20 d 20 20 d 9 20
�' � P P
� Signature County Auditor Date
�'/ We certify under ihe penalty of perjury that the above and foregoing information is true and corred and lhal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�j�ature (owner's (ull name) Person authorized by duly executed Power of Attorney
i� or by IC 6-1.1-12-.07
ull residen address of applicant Address of authorized person