HomeMy WebLinkAboutMortgage_Jones (23)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� Slale Fortn 43709 (R4 / 10-01) �
�u. �Prescribed by DeDaNren� of Loal Govemmenl Finance
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INSTRUCTIONS: �,.�AY �ile �
To be filed in person or by mail wifh !he County Auditor of the county whe2 the property is located.
Filing Dafes: 1) Real Property: During the 12 months belore May 11 0/ the year the deduction is to �E eHective. �
2) Mobile Homes assessed under IC 61.1-7: Befween January 15 and Maich 31 0/ tica year the_deduction is to tie e�ctive.
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See reverse side for additional instn�ctions and qualifica6ons. GI3SON COUN7v ;UDITOR
Applicant (
Key number / legal de tion Record number �^
/ `/ � Q I D� D� gGj � OD Page number �a�-b
�,.� �. ,
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year 'March 1, currenl 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 fhat of applicant, indicale below: Is the property in question:
� Real PropeAy ❑ Mob�e Hortie (IC 61.1-�
Name of mortgagee ar contrad seller
� —
Address of moRgagee or conVad seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of rtlortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has lhis deduIXion been requested on
county in Indiana? property for wrcent yeaR � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 0 20 20 20 � 20 Q� 20 0
p-�,��bfi � P
Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March i, 20
� nat ners (ull na e) Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
u esident address of a licant Address of authorized person
�u�by
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