HomeMy WebLinkAboutMortgage_Beghteli��STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION �--C��o---u-��qqqnt 7 Year
�j , State Fwm 43709 (R6 / 5-06) y , -� . �
� Aesaibed by Deparimem of Local Gwemment Finance �1
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INSTRUCTIONS: File Mark
To be �led in pe�son o� by mail with the CountyAuditor of the county where the p�opeRy is located. Q
Filing Dates: 1) Real Property During the 12 months befo2 ,lune I1 0/ the year the deduction is to be eflective. ��o �Tp R.
2) Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 o(the yeaUt�i���MjsYt�aB e/fectrve.
See reverse side for additional instiuctions and qualifications.
(owner or conRract buyer -
Taxing
�ons on ieverse �
�ey� mber / legal
a6-1a-�8-lo i -aod.�o3
number
number
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applica the sole legal or equitable
March 1, current year March 1, current year ownef? es ❑ No
���Ud
If no, what is his / her exacl share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that ot applicant, indicate below:
�e of mortgagee or contred seller
� a � ��
Address of mortgagee ar conhad sell (number and street, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what coun
county in Indiana?
Deduction approved in the amounl of:
20 � 20 � 20
P
Signature
Prope�iy ❑ Mobile Horrie QC 61.1-�
��� _ ��� lion been requesled on
Tent yea(? � Yes ❑ No
Dra.�er NO. . .•••••••
Card ti0: ...........,...:.....
���o��
�� � 20 � 20 __ _
County Auditor
Date
20
certify under the penalty of peryury that the above and foregoing infortnation is true and corred and that ihe applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Full resident
7d
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person