HomeMy WebLinkAboutMortgage_BradshawSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
: �� ✓ State Fwm 43709 (RS / 4-03) � , �
Prescnbed by Departmem ol Loral G6vemment Finance � �� �
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INSTRUCTIONS: �\ File Maric
To be filed in person or by mail with the CountyAuditor of the county where the propeRy is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0/ the year the deduction is to be e/fective.
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be elfective.
See reverse side for additional instructions and qualifications.
Applicant (ownerorcontractbuyer- resMctions n reverse side)
Taxing Distrid Key number / legal description Record number n�
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„ r �( _ ' � Q �T I `, `O � Page number I � �tj
l�.iw Mp-' i) 'l..IJC.J `l l t3
Assessed value of real property as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year . March 1, current year owner? ❑ Yes ❑ No
a� � °� $ao�,o�
If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of appticant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or contraG seller �
Address of mortgagee or contracl seller (number and sf2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code) ,
Does applicant own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 0 I 20 �� 20 20 20 20 20
P �
Signalure County Auditor Dale
We certify under lhe penalty of perjury that the above and foregoing information is true and correct and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners (ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Fuli resident address of applicant Address of authorized person
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