HomeMy WebLinkAboutMortgage_Caniff (7)�
; J
w.
�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
State Form 43709 �RS / 4-03) � '� �\
Prescn�ed �y Department of Loral Govemment Finance � �
!i � /J
' —� �
INSTRUCTIONS: APR i G 20�i�e Mark
To 6e Cled in person or by mail wdh the County Auditor of the county whe2 the property is IoCated.
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 0/ the year the deductio�.is to be effective. %
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2:oElbe y� fie,deducti'o� t be effective.
See reverse side for additional insWCtions and qualifications. �O GlBgpp� r j�j �`y F�,�,��
Appliwnt
Taxing Distrid
� � �l —DOO
Assessed value of real
March t, wrrent year
If no, what is his / her exact share
see iestrictions on
Key number / legal description
� � _
Mortgage / Conirad i�
March 1, current year
If name on record is different than lhat of applicant, indicate
mortgagee or contraIX seller
Record number ��
Page number � ) � �-/
(o <7
as of Is the applicant the sole legal or equitable
owneR s� Yes ❑ No
�� I
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or conVad seller (number and st2et, dty, state, ZIPd � l
e� ��
�,c,Q,o,�.
Name of assignee or olher owner or hoider of mortgage /�
Address of assignee (num6er and st2et, city, state, ZIP code) l� ��
,�_a�- o�F
s the property in question:
❑ Real Property ❑ Mobile Hmie pC Cr1.1-
oy- y7o�'
O %- J o7 --
pc�- 3� ��
Does applicant own property in any other If yes, whal counry? �'j
wunty in Indiana? �� 1( �(��r
n�,��l
COUNT DS � u� �
Deduction approved in the amount of: �✓"" ����- —° �
��oRTGAGE�� �� ao 0
. �o
1 J�i�l'
Signature
2�
��
zo r�� �
P
County Auditor
� 1
Date
on
No
�,�-
ca-
__ �'
/ 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 aforepf�ntioned propersyon March 1, 20
Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
ot applicant � (/� IAddress of authorized person