HomeMy WebLinkAboutMortgage_Carlisleti
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
� � S�ate Fam 43709 (R4 / 70-Oi)
• Presaibed by Depanrrent W Loal Govemment Finairce
INSTRUCTlONS:
Coun Township Year
� I�,' � ,
. .�L ,1�: �1
File Mark
To be filed in person or by mail with the County Audifor of the county whe�e fhe property is located. MAY � � 2003
Filing Dates: 1) Real Pmperty: Dunng the 12 montAs beJo�e May 11 0/ the year the deduction is to b ective.
2) Mobile Homes assessed under IC 61.1-7: Befween January 15 and March 31 of th year the ded�tcUO7n is to be eHective.
See reverse side lor additional inshucGons and qualifications. GIBSOA dUK";��qti�/�
Applican erorcon ract buye - ee res 'ctlons on erse s' e)
Taxing t id Key number / legal description Record number /�
W��lJc-/� ���- Q�d O(�-Cf�/ Page number O ijG�
G�
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March.t, wrrent year Marcb 1, curtent year owneR ❑ Yes ❑ No
If no, what is his / her exad share of interest? If owned with sameone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the propeRy in question:
❑ Real Properly ❑ MobBe Hmie pC 61.1-n
'ame of mortgagee or conVad seller
e
Address ot mortgagee or conVact seller (number and stieet, dty, sfate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces 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? � YesO No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 . 20 20 20 � 20 Q'� 20 �� 20
o°r/if30�' � �' f
Signature County Auditor Dale
-�/ We certiy under the penalty of perjury that the above and foregoing infortnation is true and corred and thal the applicants was / were
resident of Indiana and owner of ihe aforementioned property on March 1, 20
Signature (owners (ul ame) Person authorized by duly executed Power of Attomey
� j : or by IC 6-1.1-12-.07
ull resident address f applicant ' Address of aulhorized person
�/ B �6
------------- --- -�-------------