HomeMy WebLinkAboutMortgage_Douglas�� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
• � I State Form 43709 (RS f 4-03)
�• Ptasuibed by Department o1 Local Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor of the county where the property is located. (� E C 4 2��3
Filing Dates: 1J Real Property: Dunng the 12 months belore May 11 o/the year fhe deduction is to be eflective.
2J Mo6i/e Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to 6e e(fective.
See reverse side lor addifional instructions and qualifications.
Applirant (oyra�r contrect yer -�strictions on reverse ide)
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Taxing District K number / legai description Record number
i 3- 99 6
' � � 7 �' � Page number
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? [�1'es ❑ No
S �l 00
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 different than that of applicant, indicate below: Is the property in question:
L�Real Property ❑ Mobile Home QC fr1. i-7)
�ne of mortgagee or contract seller / �`�t�
5 ��
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
O
Drawer NO�•.•�•• �• 9. �O
Does applicant own property in any other If yes, what county? What T. --, . �n
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county in Indiana? ' - No
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�� � 7_a_�� / '7� COUNTY AUDITOF
Deduction approved in the amount of:
20 �_ 20 FJ.r 20 20 �`� 20 � 20 �q_ 20
1
Signature County Auditor Date
'� We certify under the penalty of perjury that the above and foregoing intormation is true and correct and that the applicants was I were
ident of Indiana and owner of the aforementioned property on March t, 20
atur (owner's ful name Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full resident addr of applicant Address of authorized person
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