HomeMy WebLinkAboutMortgage_Ellis (2)i i-� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�s, �r FOR DEDUCTION FROM ASSESSED VALUATION � Count Township Year
�� State Fortn 43709 (R6 / 5-06) �
� �
Presrnbed by Departmeni of Local Govemment Finance
iNSrRUCnoNS: ��� 1 2007 F;ie Marx
To be /i/ed in person or by mail with the County Auditor of the county whe�e the propeRy is lo
Filing Dates: 1) Real Property: Dunng the 72 months 6efors dune 71 0( the yea� the deduc6on eB�^�r�°
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma91$$�fjt th�educ6on is to be effective.
�Y AUDI70R
See reverse side for additional instructions and qualifications.
Applicant (owner or ct b�yer: see restrict ns on reverse side) .
� �
Taxing Dislrict Key numbe / lega escription Record number O�
Q!� — '�� -033 -GY.�.1 I�f�► Page number n�
/
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, current year ownef? ❑ Yes ❑ No
4
Ii no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of appliwnt, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
me of mortgagee or contred seller ��
Address of moAgagee or conVad seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP code)
Does appliwnt own property in any other If yes, what countyl Whal Taxing District? Has this dedudion been requesled on
county in Indiana? property for current yea�� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 _� 20 20 20 20 20
P
Signature County Auditor " Date
� We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly execuled Power ot Attomey
or by IC 6-1.1-12-.07
Full resident address ot applicant Address of authorized person