HomeMy WebLinkAboutMortgage_Doanery" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' K FOR DEDUCTION FROM ASSESSED VALUATION Coun 7ownship Year
S / Slate Fofm 43709 (R4 / 7P-07) ��
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PrewibeC by Department of Local Govemment Finance
� MAY 1 �002
1 . UCTIONS: File Ma
To 6e filed in person or by mail with the County Audifor ol the county where the property is located.
Filing Dates: 1) Real Property: During the 12 monfhs 6elore May 11 of the year the deduction is to b ct�
2) Mobile Homes assessed under IC 61.1-7: Behveen January 15 and March 31 0/ th e01�Q8d ' �. � i� tive.
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See reverse side /or additional instructions and qualifications.
Applicant (owne contract b er- s e restrictions on reverse side)
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Taxing Distrid ey number / Iegai description Record number
`��ZU�� p/9- OC� / 2 4-oo Page number Q^.�r,�
0 da.�lY
Assessed value of real property as of ttgage7Contred•indebtednessunpai�s of Is lhe applicant the le legal or equitable
March 1, curtent year arcTi 1, wrrent yea owneR es ❑ No
'�R',�5o,c1 ��o
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicant, indicate below: Is the property in question:
❑ Real Properiy ❑ Mobile Home QC &1.1-�
��ae .mortgagee�orcontrad•set r
G�Y��t.� �
s ot mortgage � conVact seller (number and st2ef, city, state, ZIP �
'�-r, �. ��'� �. `' — l�cc,��t 7�c, !i' �� ��o l - ��:31
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 Taxing Distr,"ct? Has this dedudion been requested on
county in Indiana? property for wnent yeaR� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
�
2o zo JZ� zo .a. /� 20 �� zo �. f� zo � 7 zo
s f P �
Sig ure � 9 County Auditor Date
' We certify under the penalty of peryury that the above and foregoing infortnation is true and corced and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
ature.(owriefs (ull name) /�� Person authorized by duly executed Power oi Attomey
/`, 1, .� . _ � / �L'. /�� ��, l�`_ or by IC 6-1.1-12-.07 -
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Full resident address of appli t '. ' "� , � Address of authorized person
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