HomeMy WebLinkAboutMortgage_LongaboughR'" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' : FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S '• / Slate Form 43709 (R4 / 70-01) . • � .
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� PrescribeA by Oepartment of Loral Govemment Finance —� r�
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor ol the county where the properiy is locate� E B� 6 2003
Filing Dates: 1) Real PropeRy: Dunng the 12 months 6e(o2 May 11 0! the year the deduction is to be effective.J �
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year�the7�tleducti is "o be eHective.
See reverse side /oraddifional instructions and qualifica6ons. ,,, ��a�NTt" nMiTOR
Tauing Distrid
of real property as of
March 1, current year
�e restnc on on reverse side) �
� number / legal description
Record
� fy� -� / �^ �� I Page number �� ��/
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Mortgage / Contrad indebtedness unpaid as of Is the applicant ihe sole legal or equitabte
March curtent year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? � If owned with someone other than spouse, indicate with whom.
If name on record is differenl lhan that of applicant, indicale below: Is lhe property in question:
❑ Real Properly ❑ Mobile Home pC 61.1-�
'ame of moRgagee or contracl seller
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Address of mortgagee or contrad seller (number and street, ci , state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand streef, ciry, state, ZlPcode)
Does applicant own property in any other If yes, what county?
county in Indiana?
Dedudion approved in the amouni of:
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Signature
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� Drawer N • • • • ''G auested on
C( 3`�.J . 7 Yes� No
_ Card N�•�; �; �00
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County Auditor
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/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal ihe applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Person aulhorized by duly executed Power
or by IC 6-1.1-12-.07
ull r�i0ent atltlress o applipnP � � � IAddress of authorized person
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