HomeMy WebLinkAboutMortgage_CuzzortSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Co Tow ear
S / State Form 43709 (RS / 4-03)
� Ptesaibed by Department ot Lorai G6vemment Finar�ce N 1 9 2006
INSTRUCTIONS: �-y,;����
To be filed in person or 6y mail witA the County Auditor of the county where the property is located.
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Filing Dates: i) Real Property: During fhe 12 months before May 11 01 the year the deduction is to be e�BkUPN COUNTV AUDITOR
2) Mo6i/e Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of the year the deduction is to be eNective.
See reverse side for additional inshuctions and qual�cations.
6uyer-see
Taxing
Assessed value of real property as of
March 1, wrtent year
no, what is his / her exad share of interesl?
on reverse
Key number / legal description
number�`� _ � (�j ��
D
o a � _ � Page number
Mortgag / Contrad indebtedness unpaid as of Is lhe applican�sole legal or equitable
March 1, cunent year owne(? es ❑ No
%� aoa
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contracl seller
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Ta�cing I
county in Indiana?
i i n cei i/- nt —i t,
Deduction approved in the amounl
20
Signature
20
3� COUNTYAUDITOR
20 Q�_ 20 20
�
County Auditor
Is the property in question:
❑ Mobile Hame pC 61.
Dra��`er NO. �5�..�.g•9,L
Card.\0 ............:......... -
, -.i '-� _ �
20
20
certify under the penalty of perjury thai the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforemenlioned property on March 1, 20
Signature (owne/s full name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
resident �ddress of applicant� 0 0 _ �Address of authorized person