HomeMy WebLinkAboutMortgage_Compton (2)a� '"'�\ STATEMENT OF MORTGAGE OR CONTRACT IN�7E8TEDNESS
i���' FOR DEDUCTION FROM ASSESSED VALUATION Count _ Township Year
.'� State Form 43709 (R6 / 5-06)
�
� Presctibed 6y Deparimen� of Local Govemmerri Finance \
INSTRUCTIONS: SEP 1 D'�LO�`
To be (iled in person or by mail with fhe County Auditor of the county where the p�operty is located.
Filing Dates: 1) Real Property: Dunng the 12 months befoie ,lune 17 of fhe year the deduction is to be e e. /�,(!��
2) Mobile Homes assessed unde� lC 6-1.1-7: Between January 15 and Ma�ch 2 of the year�t�F� V o be effective.
See reverse side fo� additional instructions and qualifications. OIBSON COUNTY AUDITOR
Applicant
Taxing
buyer
��� �
Assessed value of real property as of
March 1, wrtent year
16 no, what is his / her exad share of interesY?
If name on record is different than
of mortgagee or conVact
on reyerse side)
Key number / legai description
�G //�i ��ooa. �i
MoRgage / Contrect indebtedness unpai
March 1, wrrent year
indicate below:
Address of moAgagee nr wntrad seller (number and street, ciry,
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand
Does applicant own property in arry
county in Indiana?
Deduction approved in the amount of:
20
Signature
P3��
�
state, ZlPcode)
If yes, what counry?
Record number
number �n/ a
"/(D
as of Is lhe applicant the sole legal or equitabli
ownef? ❑ Yes ❑ No '
P��� I
owned with someone other than spouse, indicate with whom.
ZIP
What Taxing Distrid?
COUNTY AUDITOR
20 20 20
County Auditor
s the property in
❑ Real Properfy ❑ Mobile Hmie (IC 61.1
Has this dedudion been requested on
property for current yeaR � Yes ❑ No
20
Date
20
�We ceAiy under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
esident of Indiana and owner of the aforemenlioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
j( I M.� �.� .�1�����,1 or by IC 6-1.1-12-.07
/ �'L!I
F�il•res'dent address ot applipnC ' Address of aulhorized person
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