HomeMy WebLinkAboutMortgage_KellR'" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSED VALUATION
S- J Sfate Form 43709 (Ra / 70.01)
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� PrescribeA by DepaM�enl of Lo�al Govemment Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor o/ the county whe2 the property is located.
Filing Dates: 1J Real Property: Dunng the 12 months be)ore May 11 of the year the deduction is to be effect(j��N � 3 2�03
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the year the deduction is to be eHective.
See reverse side for additional instructions and qualifications. / �j /n/ (//�
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Applicant (owne rcontract yer- ee restric ions on rev e ide)
Taxing Distrid Key number / legal descri ion Record number
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� Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, curcent 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 wilh whom.
If name on record is dif(erent than ihat of applicant, indicate below: Is the propeAy in question:
❑ Real PropMy ❑ Mobile Home (IC 61.1-�
me of mortgage or conVact seller �—
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Address of mortgag e or contrad seller (number and streef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Dces applicant own property in any other If yes, what county? What Taxing Distrid? Has lhis deduction been requested on
counfy in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deducfion approved in the amount of:
20 U 20 20 20 20 �� 20 �_ 20
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Signature � County Auditor Date
�/ We certify under the penalty of perjury that the above and foregoing informalion is true and corred and lhal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Si n ure (owne/s full name) . V� " ' Person authorized by duly executed Power of Attomey
c./1r)�(.�.(.,Q. F,c.,c..�� or by IC 6-1.1-12-.07 .
F I resident address of applipnt Address of aulhorized person
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