HomeMy WebLinkAboutMortgage_Dortch� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION C n w hi vear
�. w� / Stata Fortn 43709 (RS / 4-03J
�� PrescnDCd by DepaRment of Local Guvemment Finance ,1A N 1 2 2005
INSTRUCTIONS: �/y � ,a�anea�
To be filed in person or by mail with the County Auditor of the county where the property is locat�� N o/ r�
Filin Dates: 1 Real Pro eR : Durin the 72 months be%re Ma 11 o/the SO C UNTY AUDITOR
9 1 p y g y year the deduction is o e e�techve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 0! the year the deduction is to be effective.
See reverse side for additional instructions and quali�cations.
Applicant (own nt c buyer - see res ions o rev rse side)
Taxing tnd Key number / legal description Record number h�
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Assessed value of real properiy as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legai or equitable
March 1, curcent year March 1, nt 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 different lhan ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.7-�
�me of mortgagee or contracl seller �// �
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Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
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Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
counry in Indiana? propeAy for current yeaf? I� Yes O No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 Q�__ 20 20 20 20
P P
Signature County Auditor Date
� We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was! were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owne/s full name) Person authorized by duly executed Power of Atlomey
� or by IC 6-1.1-12-.07
Full resident address of a licant Address of authorized person
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