HomeMy WebLinkAboutMortgage_Douglas (3)��
e R�"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
`f-- _, :"s FOR DEDUCTION FROM ASSESSED VALUATION �t-�
y State Fwm 43709 (R4l 10.01) ��� j}--j
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�� PrescriDea W Devanment of Lora� Govemment Finance JSJ
MAY ����pg
INSTRUCTIONS:
To be (led in person or by mail with fhe County Auditor of the county whe2 the propeRy is focated.� �7
Filing Dates: 1) Real Property: During the 12 months be(ore May 17 0l the year the deduction is fo effectiae_� �/��I
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Maich 31 0/ lhe ye� a(h� d U�N<<�AUDI?p(��'/tive.
See reverse side for additional instructions and quali�cations.
(owner or contract 6uyer - see n
•,. �, ��.q�QS
'I (��u�e�i Jer I wP
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share
on reverse side)
Key number / legal description
�010- OD�10-o�
MoRgage / Contract indebtedness unpaid as
March 1, current year
' 3 i1, OOU�D 0
If name on rewrd is different lhan ihat of applicant, indicate
Record number
�p03 �
Pa e riumber
0 6'-� '
( Is the applicant the sole legal or
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with v�hom.
of moAgagee or contrad seller
,t ,-a� � ►J, A .
ss of rtgagee or contracl seller (number and street, city, state, ZIP
Name of assignee or other owner or
Address of assignee (number and st2et,
Does applicant own property in any
county in Indiana?
20
Signature
the amount of:
� of moRgage
:ity, state, ZIP code)
If yes, what counly?
�.���
i'T-/�aa �-
s the property in
❑ Real Property
❑ Mobile Home (IC &1.1
- 3 �3 0
VJhat Taxing District? Has this deduction been requested or
property for current year?� Yes� N
COUNTY AUDITOR
20
County Auditor
20
20
Date
20
I/ We ceAify under lhe penairy of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
a resident o( Indiana and owner of the aforementioned property on March 1. 20 .
ii ture (owr�.e�s full name) Person authorized by duly executed Power ot Attorney
( . ) or by IC 6-1.1-12-.07
Z/
„ __ __, _�,.,,._ „� ,,,,,,r ,,, Address of authonzed person
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