HomeMy WebLinkAboutMortgage_Bridges (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-� FOR DEDUCTION FROM ASSESSED VALUATION
` � State Fortn 43709 (R3 / 10-00)
PresaibeC by State Board ol Tax Cortunissiorcrs
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effective. See
FORM 5
Coun Township Year
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AUG 17 2001
reverse s�ae tor aaaroonal insvucuons and qualmpt�ons. �5 _����^-^�Y-�-1'
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Applica (o eror n t buye see r�stn 6o s n ie e e side) o .°""":• •�"-:,: ^��:;vK �.
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Ta�cing Disfid ey number / legal desuiption Record number �/
� Page number �
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March 1, current year March�curtent year ' owner? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
= of mortgagee or contract seller
Address of mortgagee or contract seller (number and street, city, state, ZIP ' /�
�7�.
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and sUeet, aty, state, ZlP code)
Does appliqnt own real property in any If yes, what county? What Taxing Distrid? Has this dedudion been requested on
other county in Indiana? property for current yeaf? ❑ Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
�a
20 � a �- 20 � 20 0 20 2o zo zo �
5 c�.�3 -� �ea$ � � P
Signa e County AudRor Date
e certify under the penatty of perjury that the above and foregoing information is W e and correG and thal lhe applicants was / were
ident of Indiana and awner of the aforemenlioned property on March 1, 20
Sign t (owne sJuNy�ame) Person authorized by duly executed Power of Attomey
� J ' or by ic s-�.�-i2-.o�
ull re ident address of appli Address of author¢ed person
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