HomeMy WebLinkAboutMortgage_Whitten (2)rt�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
ti��-' • FOR DEDUCTION FROM ASSESSED VALUATION Coun jTownship Year
�.. � Slate Fortn 43709 (R4 / 10-01) T� �
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� PrescriDeG by DepaM�ent ci Loral Govemmeni Finance
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INSTRUCTIONS: �V� 1 � 2�03nna� �
To be filed in person or by mail with Ihe County Auditor o/ the county whe2 fhe property is /ocated. 1
Filing Dates: 1) Real PropeRy: During the 12 months be/ore May 11 0/ the year the deduction is.to 6e elfective. �
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 oGthe year the�deduction'is�to b�e eHective.
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See reverse side for additional instructions and qualifications. �� c�,� �' �
App t(owner or contract b� - se� strictio s reverse side) �
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Tauing D trid Key number / I e'ptio Record number
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vJ O _ OO/ 7— ` Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, wrtenf year March t, current year ownef? ❑ Yes ❑ No
CS/ / �
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 than Ihat of applicant, indicate below: Is the property in question:
❑ Real Properly ❑ Mobile Hmie QC 61.1-�
�me of mortgagee or conlrad seller �/�
Address ot mortgagee or contrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requesled on
county in Indiana? property for wrrent year? � Yes � No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 0 20 20 20 20 �_ 20 � 9 20
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Signature County Auditor Date
' 1 We certify under the penalty of perjury thal the above and foregoing infortnation is true and corred and thal ihe applicants was / were
�resident of Indiana and owner of the aforementioned property on March 1, 20
Si re (own ame Person authorized by duly executed Power of Atlomey
� or by IC 6-1.1-12-.07
F resid nt address of app iqnt Address of authorized person