HomeMy WebLinkAboutMortgage_Mace;� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
'�/ • State Form 43709 (R6 / 5-061 � � �
� M Presaibed by Department of Local Gwemmem Finance
INSTRUCTIONS:
Township Year
JUN I �e��
To be filed rn peison or by mail with the County Audito� of the county where the property is located. �
Filing Dates: 1J Real Property: During the 12 months before ,lune 11 of the year the deduction is to eHective�
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of the�3�RAF,��rqtiQnA' aqr Relfective.
1
See reverse side for additional instnictions and qualificafions.
Ap licant (owne�orcontracf b�yer- see resfrictions on erse side)
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Taxing Distri Key number / legal description Record number � Q Q/
l�
��O-� �-c,cl'�/ .Z/c -OY- �S -/ o/ -OUV• y 4 3-�lo Page number � � Y �
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcenl year March 1, wrrent year owne(? ❑ Yes ❑ No '
SO 0�'
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC Fr7.1-�
me of mortgagee or contrad seller — --
. � ��, CC7�i
Address o/ mortgagee or contrad selier (number and st2et, city, state, ZIP ��I
Dra���cr 1\`0 ...................
Name of assignee or other owner or holder of mortgage J��L4/
C:ll"(i �� . .....................
Address of assignee (numbe�and st2et, city, state, ZIP code) ���� ���`-'
Does applicant own property in any olher If yes, what wunty? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for curtent yeaf? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
20 � 20 �_ 20 �_ 20 20 20 20
P � P
Signature County Auditor Dafe
' We certify under the penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
resident of lndiana and owner of the aforemenlioned property on March 1, 20
ignat (own rs 1 na e Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
r
uli resident address,qf �ppp�n� _ � Address of authorized person
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