HomeMy WebLinkAboutMortgage_EadsSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� � State Fwm 43709 (RS / 4-03)
� PiesaibeE by Departmem oi Lors;l Gtivemment Finance
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INSTRUCTIONS: `ry�' File Mark
To be filed in person or 6y mail with the CountyAuditor of the county where the property is located. �i � 12_-d
Filing Dates: 1) Real Property: Dunng the 12 months before May 11 0/ the year the deduction is to be eBective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oI the year the deduct�oiilis to�be4effe�s�iLe.
See reverse side for additional instn�cfions and qualifications.
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or con�rwa wver -see
Taxing Distrid / � Key n�mber / leg�l descnption Record number O��
Vj �/�'1 �� /C /0 � o V V J(! "� age number a�
Ml., ° - l V �
Asses ed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1,'current year March 1, current year owneR ❑ Yes ❑ No
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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 diiferent than thaf of applicanl, indicate below:
,me of mortgagee or contrad seller //�
Address of mortgagee or cont�ad seller (number and st t, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? I What Taxing Dislrid?
county in Indiana?
Deducfion approved in the amount
20
Signature
20
COUNTY AUDITOR
20 20 20
1
County Auditar
Is the property in question:
❑ Real Pmperty ❑ Mobile Home (IC 61.1-�
Has this deduc[ion been requested on
property for current yea(? � Yes ❑ No
�
20
We certify under the penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
inature (owners full name Person authorized by duty executed Power of Attomey
���` _ � � � or by IC 6-1.1-12-.07
resident addFess of applicant Address of aulhorized person
f?f. / 3m x 1�' 1� ,�a��_ c�n ,