HomeMy WebLinkAboutMortgage_Banks� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�� J State Form 43709 (R5 / 4-03) .
� «.
Piesai�ed by Department of Local Govemment Finance
INSTRUC710NS:
Coun Township Year
_ __{ '
File Matk
To be filed in person or by mail with the County Auditor of the county where the propeRy is located. MAY 5 20�6
Filing Dates: 1) Real PropeRy: Dunng the 12 months before May 11 0/ the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 otthe year the d��ion Is�to �ffective.
See reverse side for additional instructions and qualifications. pleSON CO NTY AUDITOR
Applicant (owne�contract buyer- see
Taxing
on reverse side)
Key number / legal description � Record number
I�_ Q I/ l/ b�O� Page number
y -�
�
�
Assessed value of real property as of MoAgage / ContraG indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
D
If no, what is his / her exact share of interesl? I( owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that oi applicant, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobile Home QC 61.1-�
of mortgagee or contract seller
�
of mortgagee or conlrad seller (number and st�eet, city, state, ZIP
Name of assignee or other owner or
assignee (numberand
Dces applicant own property in any
county in Indiana?
20
Signature
approved in fhe amount of:
20
"
County Auditor
Has this dedudion been requested on
property for current yea(? 0 Yes ❑ No
20
Date
20
We certify under the penalty of peryury that the above and foregoing information is true and correct and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20 �__
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Fuilfi�sident address of applicant IAddress of authorized person
�C � �% S/.�4vC /ktb�r: //t�....,.�a.. �