HomeMy WebLinkAboutMortgage_BacchiR�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S- J S�ate Fofm 43709 (R4 ! 70.01) ,
t yi.
�, PreSCriDeO by DePaNreN o( Local Govemment Finance O"y-�
G /
INSTRUCTIONS: �'\ \' File Mark
To be filed in person or by mail with the County Auditor ol the county where the property is located.
Filing Dates: 1) Real Property: During the 12 monfhs before May 11 0l the year the deduction is to 6e e(lective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the year the deduction is to 6e effective.
See reverse side (or additional instructions and qualifications.
Applicant (ownerar ntract buyer see iestndio n 2verse side)
Taxing Distrip Key number / legal description Record number �
�I _ ��� � / Page number
� �J�1
Assessed value of real property as of Mortgage / Contrect indebledness unpaid as of Is the applicant th sole legal or equitable
March 1, curtent year March 1, current year ownef? ❑ Yes ❑ No
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Pmperty ❑ Mobile Home (IC 61. t-�
ime of mortgagee or contrad seller .
� �
Address of mortgagee or contrad seller (number and sfieet, city, state, ZI
3
Name of assignee or other owner or holder of mortgage
„�. c� ' SIS 3
Address of assignee (number and street, city, state, ZIP code) Q
Does appliwnt own property in any other If yes, what county? What Taxing District? Has this deduction been requested on
counfy in Indiana? property for current yeaR � Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amouni of:
zo _ J�3 zo � zo �_ zo � zo 0 zo � zo 0 9
p-rn- a A— � P � �
Signature County Auditor Date
;�'/ W certify under lhe penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
. sident of indiana and owner of the aforementioned property on March 1, 20
�� gn u(owners Il na Person authorized by duly execuled Power of Attomey
�7 � or by IC 6-1.1-12-.07
v�.
Fu ent address ppliqnt Address of authorized person
�