HomeMy WebLinkAboutMortgage_Barrett (4)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
�- � FOR DEDUCTION FROM ASSESSED VALUATION
i � State Fwm 43709 (R4 / 70-07)
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� Preuribed by Department of Local Govemmeni Finance
� �INSTRUCTIONS: � � ile M�
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 tAe 12 months befo2 May 11 0/ the year the deduction is to 6e effective. (��3
2) Mo6i/e Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the year the �i�ction�is to 6e
See reverse side for addifional instructions and qualifica6ons.
(ovmer or
Taxing
Assessed value of real property as of
March 1, current year
If no, what is his / her exad share of interesl?
reverse
Key number / leg�l�escpptjon Record number
/� � _ ���� ��V
Page number
Mortgage / Contrad indebtedness unpaid as of
March 1, cu��ar �
SO
name on record is different than ihat of applicant, indicate below:
e�me of mortgagee or conVact seller �I �
Address af mortgagee or contrad seller (number and sti
Name of assignee or other owner or holder of mortgage
(number and street, city, sfate, ZIP code)
Does applicant own property in any other I If yes, what county?
counry in Indiana?
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Signature
approved in the amounf of:
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Is the applicant the sole legal or equitabte
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
stafe, ZIP
Is the property in question:
❑ Real Property ❑ Mohite Home pC 61.
Taxing District? Has this dedudion been requesled on
property for curcent year? 0 Yes ❑ No
COUNTY AUDITOR
20 (Ll� � 20 �,� � zo
County Auditor
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P �'
Date
e
20 - O 7
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/ We certify under lhe penalty of peryury that the above and foregoing infortnation is lrue and correct and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly execuled Power of Attomey
or by IC 6-1.1-12-.07
Full resideNt address of appliqnt Address of authorized person
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