HomeMy WebLinkAboutMortgage_Pierce� - - ---�-
e� N� �,; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�° : FOR DEDUCTION FROM ASSESSED VALUATION
`� > Slate Fwm 43709 (R3! 10.00) �
�u.
,� Presrnbetl by State BoarE ot T� Commissiorrers �
Instructions for filing:
To be filed in person or by mail with lhe County Auditor of the wunty where the property is
located during the 12 months before May 17 of the year the dedudion is to be effedive. See
reverse side for additional instructions and qualifications.
F, ti�:,
Applicant (o r or cont2ct buyer ee sfnctions n reverse side) �
Ta�cing Distnct Key number / I g I description Record number �
� � _ /� r Page number �
UJ
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? ❑ Yes ❑ No
3
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 lhat of applicant, indicate below:
e of mortgagee or contrad seller
�ess of moAgagee or contract seiler (numb d treet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
0 -
Address of assignee (number and sheet, city, state,�ZIP code)
Does applicant own real propeAy in any If yes, what county? VJhat Taxing District? Has this deduction been requested on
other wunty in Indiana? property for current year?0 Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �,� y 20 20 O 20 � 20 � 20 �� 20 �=
s Pr�l�o� P
S' nature � County Auditor Date
I/ We certify under the penaity of perjury that the above and foregoing information is true and wrrect and that lhe applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
ture (owne/s (ull name) Person authorized by duly executed Power of Attomey
or by IC 61.1-12-.07
ui si a ess of applicant Address of authorized person