HomeMy WebLinkAboutMortgage_Davis (10)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION C�oufn Year
` �� State Form 43709 (R4 / 10-01) t7 �
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Presaibed by Depa�men� ot Laal Govemment Finance N
�• 8
DEC 31.
lNSTRUCTIONS: F�le Mark
To be filed in person or by mail with the County Auditor of the county where the property is locate �
Filing Dates: 1) Real Property: During the 12 monfhs be%�e May 11 0l the year the deduction is ci6e efle ,J �� OR
2) Mobile Homes assessed under IC 61.1-7: Behveen January 15 and March 31 0 �yfj���Icfi�,r}�IS�o 6e e(/ective.
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See reverse side /or additional instructions and qualifications.
Applican er ��fract b er- se stridions on reverse ide) .
� �� �'�`'� 1C �L � ' �%T�/
Taxing Dislrid Key number / legal description Record number O�
� Page number
d/ - Z Ov L
Assessed value oi real property as of Mortgage / Contrad indebtedness unpaid as of Is the applican the so e legal or equitable
March 1, wrrent year March 1, curtent year owneR ❑ Yes ❑ No
7�9 �
If no, what is his / her exact share of interesl? Ii owned with someone other lhan spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the property in question:
❑ Real Pmperty ❑ Mobile Hmie (IC 61.1-�
�me o( mortgagee or contrad seller �-y��
` I 11 00�- 3 �)�
Address of mortgagee or conVad seiler (number an street, city, stafe, ZIP �
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Dces applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for cunent yeaR O Yes � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 2o Q� 20 �,� 20 20 � 20 � 20 �`�
Q b A' 0 /
Signature County Auditor Date
/ We certify under lhe penalty of perjury lhat lhe abave and foregoing informalion is true and correct and that the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
� Signature (owners /ull na Person authorized by duly executed Power of Attomey
• or by IC 6-1.1-12-.07
ull resident a dress of appliqnt � Address of authorized person