HomeMy WebLinkAboutMortgage_Davis (6)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION C n To ship � Year
�ti I Stata Fwm 43709 (RS / 4-03) �� 1i
� PresaiDed Dy Department of! ocal Wvemment Fina�e 0
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INSTRUCTIONS: File Ma
To be filed in person or 6y mail wfth the County Auditor of the counry where the property is located. �a� ��
Filing Dates: 1) Real Property: During the 12 months betore May 11 of the year the deduction is fo be �����. cO�1NTY AUDITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the ye r e educ wn is to be efrective.
See reverse side /or additional instructions and qual�cations.
ApplicaM (owneror ontract buyer- see
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Taxing Distri
0
/L�x�� �- ' -
Assessed value of real property as of
MarcF� 1, wrrent year
no, what is his / her exact share of interest?
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Key number / legal descript� Record number
�/ y Q�G _� Page number �49�
.
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcenl ye�� ownef? ❑ Yes ❑ No
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If ned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
of mortgagee or contrad seller
Address of mortgagee or cont�ad seller (number and street, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZlPcode)
Does applicant own property in any other If yes, what counry?
county in Indiana?
Deduction approved in the amount of:
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Signature
couNrr,
i 20
�
_ Counry Audilor
Is lhe property in question:
❑ Real Property ❑ Mobile Horne (IC fr1.1-n
"' �-- �een requested on
�OQ����3 year?�Yes❑No
DrawerN .................
Card i�'O . .....................
20
�
Date
20
�� We certify under the penalty of perjury that the above and foregoing information is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
nalu wne/s full n� Person authorized by duly executed Power of Attomey
i e,s .__ O� by IC 6-1.1-12-.07
, ss of applicant Address of authorized person
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