HomeMy WebLinkAboutMortgage_Davis (7)`° rt�" , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
° :� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S J State Form 43709 (R4 / 10-0t ) ��
Prescribe0 by Departmenl ot Loral Govemment Finance
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iNSrRUCnoNS: SEP 0 y 200�i1e Mark
To be filed in person o� by mail with the County Auditor o! the county where the property � ocated. /
Filing Dates: 1) Real PropeRy: During the 12 months 6elore May 11 of the year the dedu �n is to be e
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and Ma f�Pftte�@d��ed n to be e//ective_
" BSON CODU7y qUDITOR
See ieverse side for additional inst�uctions and qualifications.
Applicanl (owner
Taxing Dislrid
� �
buyer- see r�stnctions on reverse
Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exacl share of
' ¢ v��L �� �
Key number / legal descriplion Record number
v « — co i
O Page number
-Go /6-�
MoAgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, currenl year ownef? � Yes ❑ No
name on record is different ihan that of applicant, indicate below:
mortgagee or contrad seller
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
(num6erand street, city, state, ZlPcode)
Does appliwnt own property in any other If yes, what county? I What Taxing District?
county in Indiana?
Deduction approved in the amouni of:
20 � 20 a� 20 �
d R—
Signature
COUNTY AUDITOR
20
County Auditor
s the property in question:
❑ Real Property � Mobile Home QC fr1.1
Has this dedudion been requested on
property for current year? � Yes � No
20 O '/ 20 _
P
Date
20 O �
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1/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thaf the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Signature (owners full name) . Person authorized by duly executed Power of Attorney
�(1 � � � ,� � / or by IC 6-1.1-12-.07
is . i/lif n� /7 „v
�ress ot appucam �-��.� Address of authorized person
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