HomeMy WebLinkAboutMortgage_TurpinSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-' � FOR DEDUCTION FROM ASSESSED VALUATION /y�
.. w�� J State Fortn 43709 (R4 / 10-01) , f
Prescribed by DepaNrenl W Loral Govemment Finance �
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�INSTRUCTIONS: �/�
Coun Township Year
File Mark
To be (led in person or by mail with the County Audifor o/ the county where the property is locafed.
Filing Dates: 1) Real PropeRy: During the 12 montAs before May 11 0l the year the deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-1.1-7: BeKveen Jan�ary 15 and March 31 of the year the deduction is to be e/%ctive.
See 2verse side for additional instructions and qualifications.
Applicant (o oryronfract_buy�- 1see res 'ctions on rev�rse side) .
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Tauing Distrid Key number / legal description Record number O�
.�,,,.� 9- o00 .QO Page number /Q Q�
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, curtent year March �rrent year , owner? ❑ Yes ❑ No
d�040.
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
❑ Real PmpeAy ❑ Mobile Home pC Cr1.1-�
ame of mortgagee or contrad seller '
Address o( mortgagee or contrad selle umber and st t, city, state, ZI
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, city, state, ZIP code)
Does applicanl own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current year?� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20�_ 20
D' �i9,� I°TAOoA � P
Signature County Auditor Date
I/ We cxrtify under the penalry of perjury lhat the above and foregoing infortnation is true and corred and that ihe applicants was / were
resident of Indiana and owner of the atorementioned property on March 1, 20
Signature (owners full na ) Person authorized by duty executed Power of Attomey
' or by IC 6-1.1-12-.07
F I r ' ent ress of appli t Address of authorized person
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