HomeMy WebLinkAboutMortgage_CarverSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�+ J State Form 43709 (RS / 6-03)
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� PrescriDed by Deparimeni of Local Govemment Finance
INSTRUCTlONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Pioperty: During the 12 months belo2 May 11 0/ the year the deduction is to
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the
See reverse side for additional insbuctions and qualifications.
or contract buyer-
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6e�e/fec�ive� �� � t�
year fhe.deduction �ys to be _eftective.
,iUN 7 2004
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Key number / legal desuiption Record number
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Assessed value of real property as of MoRgage / Contra
March 1, current year March 1, currenty
If no, what is his / her exad share of interest?
If name on record is different than that of appliwnt, indicate below:
of mortgagee or contrad seller
Address of mortgagee or contrecl seller (number and street,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appliwnl own property in any other I If yes, what county?
county in Indiana?
Deduction approved in the amount
20
Signature
20 J16 I 20
6 `�
� t �_ ,n (l� Page number ^� �/'
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indebtedness unpaid as of Is the applicant the sole legal or f
r O owne(? � Yes ❑ No
O
If owned with someone other than spouse, indicate wilh whom.
state, ZIP
What Taxing Distrid?
COUNTY AUDITOR
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County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Hort�e OC 61.
Has this deduction been requested on
property for current year? � Yes� No
20 � 20 � 20
P
Date
We certify under the penalty of perjury lhat the above and foregoing information is true and corred and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March t, 20
�n e(owners full na e) , Person authorized by duiy executed Power of Attomey
or by IC 6-1.1-12-.07
II resident address o applicant Address of authorized person
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