HomeMy WebLinkAboutMortgage_Renneri�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i' = FOR DEDUCTION FROM ASSESSED VALUATION
': �_ �� State Fortn 43709 (R6 / 5-06)
Presaibed by Department of Loral Gwemmen� Finance
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Coun Township Year
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INSTRUCTIONS: � � File Mark
To be �led in person or by mail with the County Audiror of the county where the propeRy is located. _, ��'�) t.�� � j
Filing Dafes: 1) Real Property: During the 12 months 6efoie �une 11 0/ the year the deducUon is to be effective.
2) Mo6iie Homes assessed unde� IC 61.1-7: Between January 15 and March 2 0! the year the-A�uc6o� effective.
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See reverse side for additional instructions and quali�cations. ^ ��,j C��NTY AUDITOR
Applicant
Taxing
on reverge
Key number / legal description
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p( �—�a,�s \ O 2 1— Mp. D P number �� �
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Assessed val of real property as of Mortgage / Conirad indebtedness unpaid as of Is the applipnt the sole legal or f
March 1, curtent year March 1, curtent year ownef? ❑ 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.
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If name on record is dif(erent than tl�at of appliwnt, indicate betow: the property in queslion:
of moAgagee or contrad seiler
of mortgagee or conVact seller (number and street, city,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces appl�^=�+ �+wn oronertv in any other If yes, what counry?
counry in � —
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Signature
Dra�ser i\'O.. .�. .
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Taxing District?
OUNTY AUDITOR
Card i\'p. ��3�
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# 35� y70. u? .........
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County Auditor
� Real Prope�iy ❑ Mobile Home (IC 61.
Has this dedudion been requested on
property for curtent yea(? � Yes ❑ No
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Date
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certify under the penalty of perjury that the above and foregoing infortnalion is lrue and corred and thal the applicants was / were
lent of Indiana and owner of the aforemenlioned property on March 1, 20
Signature (ou�ne�rs (ull
or by IC 6-1.1-12-.07
Full resideni address of applicant Address of authorized person
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Power of Attamey