HomeMy WebLinkAboutMortgage_Moody (5)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-- FOR DEDUCTION FROM ASSESSED VALUATION
(`t , Sfate Form 43709 (R3 / 10-00)
1� Presrnbetl by State Boartl of Taz Commissioxrs
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Instriutions for filing:
To be filed in person or. by mail with the County Auditor oi the county where the property is
located during the 12 moMhs before May 11 of the year the dedudion is ro be effedive. See
reverse side for additional insWdions and qualifica5ons.
FORM 5
Coun wnship -Year
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C!5SOP. COL�P:Ty A�'DITOR
Key number / legal description Record number
� 1 �! �' � _ �� � � Page number ' � C
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Assessed value of real propeAy as of Mortgage / Contrad indebtedness unpaid as of Is the appliqnl the sole egal or equftable
March 1, current year March 1, curtent year �� tj� S'b � owneR � � Yes ❑ No
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 that of applicant, indicate below:
�e of moRgagee or contract seller �,
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Address of mortgagee or conVact seller (num er and street, city, state; ZIP
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Name of assignee or other owner or holder of mortgage ,
Address of assignee (number and sUeet, aty, state, ZIP code)
Does applicant own real property in any If yes, what county? What Taxing Distrid? Has this deduction been requested on
other county in Indiana? property for current yeaR � Yes 0 No
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COUNTYAUDROR
Deduction approved in the amount of: �
zo�va 1,1 ' zo� 20o zo� zo zo62 zo�$_ �
5 c�.� �P� o� � � �' P
Signa re County Aud'Ror Date
e certify under tFie penalty of peryury that the above and foregoing infortnation is We and corred and that the applicants was / were
ident of Indian nd owner of the aforementioned property on March 1, 20
S' re (own s ful Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fuil r�e� �ress qi.a� I�i/pnt � ^�rm �` � ry Address of author¢ed person
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