HomeMy WebLinkAboutMortgage_Debord�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
f=- "'" FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
�` �. � Sfa;e Form 43709 (R5 / 4-03)
� P2scnDeG Gy Department of local Govemment Finaxe
INSTRUCTIONS: � � � �}File aric
To be filed in person or by mail whh (he County Auditor of fhe county whe�e the property is loc d. �� �
Filing Dates: 1) Real Property: During the 72 months before May 11 01 the year the deduction is to be eRective.
2) Mobile Homes assessed under IC 6-1.1J: Between January 15 and March 2 o/the y�fjF�e $eau��js to be eRective.
See reverse side for additional instructions and qualifications.
. �la�, ,a�' .
(owner o�c[�tract buyer
Taxing District
Assessed value of real property as of
March�.1, wrrent year .
If no, what is his
exact share ofinterest?
Key
� oq reverse side)
nF be legal descripti�
D /�-03 95 y- oa
Mortgage / Contract indebtedness unpaid as
March 1, current year
name on record is different than that of applicanf, indicate below:
of moRga9ee or contract seller
ot mortgagee or contract se�ier (number and street,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Record number
Page number / �� —
ro
f Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
owned with someone other than spouse, indicate with whom.
ZIP
Does applicant own property in any other If yes, what county? What Taxing District?
wunty in Indiana? -
�
U0� � �l7 roR
Deduction approved in Dra�ver NO.� .......-......
zo 0 zc Card NO . .....................
� I ��
Signature
�
County Auditor
�
s the property in question:
❑ Real Property ❑ Mobile Hmie pC fr1.
Has this deduction been requested on
property for current year?� Yes❑ No
zo
Date
zo
We certify under the penalty of perjury that the above and toregoing information is true and corred and that the appiicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
��ure ners full name) Person authorized by duly executed Power of Attomey
e_
---�g�� Q �, or by IC 6-1.1-12-.07
applicant Address of authorized person