HomeMy WebLinkAboutMortgage_Pinkstonje` y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�s� FOR DEDUCTION FROM ASSESSED VALUATION _. C u 7o s ip Year
�• � SUte Form 43709 (R6 / 5-06) '
M�
� Presaibed by Oepartment of Local Govemment Finance
INSTRUCTIONS: �� � �
To be tiled in pe�son or 6y mail with the County Audito� ot the county where the property is located. -
Filing Dates: 1) Real Property: Dunng the 12 months before June I1 0/ the year lhe deduction is to be �f��� COUNTY AUDITOR
2) Mobile Homes assessed under lC 6-1.1-7: Belween January 15 and March 2 of the year the deduction is to be eKecfive.
See �everse side for additional instructions and qualifrcations.
Appli t(ownerorcon ct6uyer-s
Tauing Distrid � �
;�i��-t ",� `�-�
Assessed value of real property as of
March 1, curtent year
If no, what is his / her exad share of interest?
Ke�Y�ons on reve e side
al description
,26-05-58-008 -
Oo.l_o�3-0/ 8
Record
PagE
MoRgage / Contrad indebtedness unpaid as of
March 1, current year
��,00�
nunwe� � Q � �
Is the applicant the sole legal or
owneR ❑ Yes 0 No
If owned with_ so� other than spouse; indicate with whom.
If name on record is different than that of applicant, indicate below: /f%/ ry
DI'a�Ye1' �r�..�"!!./-.. ���Co
• . � .
me of mortgagee or contrac[ seller ' �
/ ard �\'O: .:...:`- - —
Address of mortgagee or conVad seller (numbe nd street, city, state, Z`� ����, QO(�. O Ci
Name of assignee or other owner or holder of mortgage '
Address of assignee (num6er and street, city, state, ZIP crode)
Does applipnt own property in any other I If yes, what counry?
county in Indiana?
Deduction approved in the amounl of:
20 0� 20� 20
P �
Signature
�
61.1
What Taxing Distrid? Has this dedudion been requested on
property for current year? � Yes ❑ No
COUNTY AUDITOR
�
County Auditor
20
�
Date
20
I/ We certify under the penafty of perjury that the above and foregoing infortnation is true and correcl and that ihe applicanls was / were
tesident of Indiana and owner of the aforemenlioned property on March 1, 20
(owne/s full
_ �
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
applipnt �Address of authorized person