HomeMy WebLinkAboutMortgage_BarkerSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
♦ / State Fwm 43709 (R5 / 4-03)
� PrestriDed by Department o( Local Govemment Finance
INS7RUCTIONS: C� ' .! -� File Mark
To be filed in person or 6y mail with the County Auditor of the county where the property is !p ceted� �f h�,� � j/
Filing Dates: 1J Real Property: During the 12 months before May 11 0l the year the deduction is fo be etfectivne. �J l�d'
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 oI tAe year th deduction is to be effective.
See reverse side for additional instructions and qualifications. � � N 1� Z0�4
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A pli t(owne oncontra r- see res 'c6ons on iaverse side) /,�� ""-"""✓ i 1-��'
a1;.�.0!q.-,riqdTy tiUD:T.r,':
Taxi g Di rict Key number / legal descriplion Record number /-� �
Page number lJ
/1-f/►u'.�d� -a���3 � �ai�
Assessed value of real property as of M a e/ ConVad indebtedness unpaid as of Is lhe applipnt ihe sole legal or equitable
March 1, wrrent year MarcF� current year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different ihan thaf of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
ame of mortgagee or contrad seller /'� �
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Address of mortgagee or conVad seller (number and street, aty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant awn propeRy in any other If yes, what county? What Taxing District? Has this deduclion been requested on
county in Indiana? property for current yea(? � Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 _n� 20 20 �� 20 20 D 9 20 20
P '� P
Signature County Auditor Date
'/ We certiy under the penalry of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
; resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur owne(s lufl name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
II resident address of applicant Address of authorized person
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