HomeMy WebLinkAboutMortgage_Anderson...,.
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
� �N� / Stata Fwm 43709 (R514-03)
� PresmEed by Department of Local Govemment Finance ��
wsrRUCrioNS: FEB 2 g 2001
File Mark
To be �led in person or by mail with !he County Auditor of the counry whe�e the propeRy is located. ���
Fifing Dates: 1J Real Property. Dunng the 12 months before May 11 of the year the deduction is`to,be.etFe'd�ve.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ye� ��e�tion is to be effective.
See reverse side for additional insWctions and quali�cations. QipgpN COUr�� �
Applicant (owner contract buyer - see resfrict' ns on re rse side)
Taxing Dislrid Key number / le al description �
2l� -lot - /�-/Dot -DO/.'153 -O�t!
�«'-b14s3"-o�
Assessed value of real properly as of -_ Mortgage / Contrad indebtedness unpaid as
March 1, current year � '— --^� �oar
Record number
Page number
Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If no, what is his / her exact share of ic ����` _A :one otherl than spouse, indicate with whom.
C�j�
If name on
than tha D � � � �1 I �
d�-
of mortgagee or contraIX selle
l:/ �
of mortgagee or contrecl seller (number and street, city, stale, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (n�mber and st2ef, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
wunty in Indiana?
Deduc6on approved in the amount oL
20 �Z 20 20
� �
Signature
What Taxing District?
COUNTY AUDITOR
20
County Auditor
20
s lhe property in question:
❑ Real Property ❑ Mobile Home (IC 61.1
Has this dedudion been requested on
property for wrrent year? Q Yes ❑ No
20
Date
20
certify under the penalty of pery"ury that the above and foregoing information is true and correct and that the applicants was / were
ent of Indiana and owner o( the aforementioned property on March 1, 20
name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
authorized person
I�— —�_-_--__--------'---- - -- ^-^