HomeMy WebLinkAboutMortgage_Haubold���A� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i'�; FOR DEDUCTION FROM ASSESSED VALUATION
��.-� • State Form 43709 (R6 / 5-OG)
Presoibed by Depariment oF Lotal Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county whe�e fhe property is located.
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune I7 0/ the yea� the deduction is to be effe,�(?�. 2 3 Z00%
2J Mobile Homes assessed under IC 6-1. ]-7: Belween January 15 and March 2 of the yea� the deduction is to be effective.
See reverse srde fo� additional instructions and qual�cations. �6µ ��
(owner or contract
Taxing Distrid
see
Assessed value of real property as of
March i, curcent year
I( no, what is his / her exact share of interest?
tions rev side)
Key number / legal description _ F
,��-�a -.sq-03a - 000. o65-Dl 9
a �y- 0006s-oo F
MoAgage / Contrad indebtedness unpaid as of
March 1, current year
10�D6�
I �
�,E7.�i�.a�a�
xd number
2oob
: number /
Is the applipnt t e s�e�l�
ownef? ❑ Yes ❑ No
If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
me of moRgagee or ntred seller
��a---� N���
Address of mortgagee or conVad seller (number and street, ci , state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, stafe, ZIP code)
Does applicant own property in any
county in Indiana?
Deduction approved in the amount
20 � I 20
V
Signature
If yes, what county? � What Taxing District?
COUNTY AUDITOR
20 20 20
P
County Audilor
� Real Property ❑ Mobile Hane (IC 61.1-
Has this dedudion been requesled on
property for wnent year? � Yes ❑ No
20
20
e
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
�nalure (owners jyjl nam� Person authorized by duly executed Power of Attomey
+�M.O� �+"-`''_"""
� or by IC 6-1.1-12-.07
II resid t ac(t�ress ot applipnt � � n Address of authorized person
/�