HomeMy WebLinkAboutMortgage_Dodge\
�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�• �� � ! State Fwm 43709 (R5 / 4-03)
� PrescnEed 6y DepaRment ot Local Gtivemment Financa
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor of the county whe2 the property is locatetl. �'-
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0/ the year the deduction is to be eflective. r��y L=� 2��a
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be efiectie
See reverse side for additional instructions and qualfications. �' � �,�,
(owner
Taxing
see
reverse side)
Key nupf6�rF legal description � Record number
\ �j — O � � — � Page number � p � /\
CJ I v
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the �s le legal or equitable
March 1, current year March 1, currenl year owneR �'Yes � No
5y�
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is differen[ ihan that of applicant, indicale below: Is the perty in question:
eal Property ❑ Mobile Home QC 61.1-�
'ame of mortgagee or contracl seller
�
Address of mortgagee or coNrad selier (number and street, city, state, ZIP n� `���
//
Name of assignee or other owner or holder of mortgage
of assignee (num6er and street, ciry, state, ZIP code)
Does applicant own property in any other I If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent year?� Yes❑ No
Deduction approved in the amount of:
� i�
Signature
�
COUNTY AUDITOR
zo 0 I zo �g_
P �
County Auditor
20 0 8 zo
�
Ti7
/ We certify under the penalty of perjury lhat the above and foregoing information is true and coned and lhal ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
�ature wn s full� )� Person authorized by duty executed Power of Attomey
� or by IC 6-1.1-12-.07
�II resident address of applicant Address of authorized person
C3�1' .S. ��.�