HomeMy WebLinkAboutMortgage_Wernz�
� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
\ ♦ Stata Fwm 43709 (RS / 6-03)
�«
Ptasai0ed by DepeRment o1 Laal Govemment Finance �
RUCTIONS: File Mark
o De filed in person or 6y mail with the County Auditor of the county where the property is located. r
Filing Dafes: 1 J Real Property: During fhe 12 months before May 11 0/ the year the deduction is to 6e eff five.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year tbe de ucB��rs t� Hec��
See reverse side for additional instructions and qualifications. ^ (J (, �� 1 LUU�
(owner or confract buyer {�e„resMctions on reverse
Key
._ GI@SOIJ CO��y.
Record number
���� � b0� - ou�a���v Pagenumber ����
Assessed value of re property as of Mortga e/ Contract indebtedness unpaid as of Is the applicant the sole legal or equita6le
March 1, current year Mar�current year owner? ❑ Yes ❑ No
O�
no,
name on
exact
mortgagee or contract seller
� `f �
If owned with someone other than spouse, indicate with whom.
of mortgagee or contrect seller (number and street, city,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIF
Does applicant own property in any other I If yes, what county? Wh:
county in Indiana?
�
Signature
20
amount of:
u
COUNTY AUL� � �,R
20 L�� 20 lJ
P �
County Auditor
O Real
� �'` � 1 ri�T S
I�J � �. �% Z
rD 3 8��3�
❑ Mobile Home (IC 61.1
Olo -y6'7
requested on
? ❑ Yes � No
20 �� 20 �_ 20
p P
Date
I/ We certify under the penalry of perjury that the above and foregoing infortnation is true and correct and that the applicanis was / were
�sident of Indiana and owner of the aforemeniioned property on March 1, 20
name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
�ent address oi applicant (j Address of authorized person
22. � � �d� l6 7 ��.�L�F�r