HomeMy WebLinkAboutMortgage_FrySTATEMENT OF MORTGAGE OR CONTRACT INDI
FOR DEDUCTION FROM ASSESSED VALUATION
t , State Form 43709 (R3 / 1 P-00)
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� PresaibeE Cy State Boartl of Tax Commissioners
Instructions for filing:
To be filed in person or by mail with the County Audflor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional insWCtions and qualfiptions.
FORM 5
OCT 02 2001
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Appiicant (ownerorcon ct buyer- see restric6ons on reverse side)
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Taxing Di 'd � Key numb r/ legal descnption - Record number
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��Qi�fl� ��� —' DU�O 3—OG Pagenumber _ /���
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Assessed value ot real property as of Mortgage / Contract indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? Ii ovmed with someone other than spouse, indicate v�ith whom.
If name on record is different than that of applicant, indicate below:
�e of mortgagee or contraG seller �
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Address of mortgagee or conVad seller (number and street,.city, state, ZIP ' O, ` 3
Name of assignee or other owner or holder of mortgage � �
Address of assignee (number and street, ary. state, ZIP code)
Does applipnt own real property in any If yes, what county? What Tauing DisVid? Has this dedudion been requested on
other county in Indiana? property for wrrent yeaR � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ `� � 0 20 20 20 20 20 Q� 20 �_ �
� �.3�;� P P �
Sig ture County Auditor Date
I/ e certify under the penalry of perjury that the above and foregoing information is We and conect and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signatu e ners full na e) Person authorized by duly exearted Power of Attomey
� �— or by IC 61.1-12-.07
resident addr of a pli nt Addreu of author¢ed person
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