HomeMy WebLinkAboutMortgage_Mitchelle`"rt�'� t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
e�� .: FOR DEDUCTION FROM ASSESSED VALUATION
'y : � State Form 43709 (R4 f 70.01)
� Prescnbcd by Departnent ot local Govemment Finance
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INSTRUCTIONS: rj'"� � � � F�M k
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To be filed in person or by mail with fhe County Auditor o/ the county whe2 the propeRy �s�cat
Filing Dates: 1) Real PropeRy: Dunng the 12 montbs 6e%�e May 11 of the year the deduction is ���e�ctivqn��
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 of e the b�� t�on is to 6e ef/ective.
See reverse side !o� additional instructrons and quali�cations. /` ��/ „ n
Applicant
- see
Tazing Distrid
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Assessed value of real property as of
March t, current year
If no, what is his / her exacl share of interest?
If name on record is different than that
mortgagee or contract seller
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Key number / legal description Record number
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Morfgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year �v owneR .❑ Yes ❑ No
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indicate below:
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Address o( mortgagee or contrad selier (number and street, city,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and streef, city, state,
Does applicant own property in any olher If yes, what county?
county in Indiana?
Deduction approved in the amount of:
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Signature
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If owned wilh someone other than spouse, indicate with whom.
ZIP
What Taxing District?
COUNTY AUDITOR
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County Auditor
20
s the property in question:
❑ Real Property ❑ Mobile Home pC Et.t-�
e
(7 �a`I I y3
Has this dedudion been requested on
property for current year?� Yes❑ No
20 �_ 20
�
Date
We certify under the penairy of perjury that the above and foregoing information is true and corred and that the applicants was / were
�esiden Indiana and owner of the aforementioned property on March 1, 20
nat e( ner's full n,�aAm� Person authurized by duly executed Power of Attorney
� . _ �� /� /{'/. ,/1 or by IC 6-1.1-12-.07
address
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Address ofauthorized person