HomeMy WebLinkAboutMortgage_Burr� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
` FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�'. w� / Stata Fwm 43709 (RS / 4-03) � � �
� PreSCADed Gy Depanmeni of Local Govemment Finance
INSTRUCTIONS: SEP `Z�e�O�
To be filed in person or by mail with the Counry Auditor of the county where the property is located
Filing Dates: 1) Real Property: During the 12 months 6efore May 11 of the year fhe deduction is t e eflecfi
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of t y�� �� ctive.
See reverse side for additional instructions and qualifications.
buyer-
0
Assessed value of real property as of
March i, curtent year
If no, whaf is his / her exacl share of interest?
on re�rse side)
Key number / legal description Record number O�
�/9_ Q/��� — ,� Page number � ^�
�
MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
If owned with someone other lhan spouse, indicate wilh whom.
If name on record is different than that of applicanl, indicate below:
�me of moAgagee or contrad seller
�, ,� Da�
Address of mortgagee or contrect selier (number and st�eet, aty, state, ZIP
Name of assignee or other owner or holder oi mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does appliwnl own property in any
counry in Indiana?
Deduction approved in the amounl of:
zo Q�
Signature
za .�,�
r If yes, what county? W
couNrv a�
20 20 0
� I
County Auditor
Is the property
❑ Real PropeAy ❑ Mobile Home (IC 6�7.1-�
Taxing Distrid?
a/ �
�ra"et�O ,,..
Cara�� .
Date
/ i
� • requested on
��X 'DYes❑No
^. v
l
/
/ We certify under the penalty of peryury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned propeRy on March 1, 20
��
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person