HomeMy WebLinkAboutMortgage_Dyer (3)rt�° � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- t FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S �� State Fortn 43709 (Ra / 10-01)
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� Prescribed by Depanmenl W Local Govemment Finance
INSTRUCTIONS: File Mlerk 7�-�
To 6e filed in person or by mail with the County Audifor of the county where the property is located. ��� 9� �
Filing Dates: 1) Real Prope�ty: Dunng the 12 months 6eloie May 11 07 the year the deduction is to be effec rve. 1�y
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ the year� deduc(i �003 be eflective.
See reverse side for additional instiuctions and qualifications. �,
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Applicant (owner contract buyer - see restrictions on reverse side)
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Taxing Dislrid Key umber / legai description
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Assessed value of real property as of Mortgage / Contrad indebtedness
March 1, current year March 1, current year
/ her exacl share of interest?
If name on record is difterent than that
S,c2� ti
��ne of mortga ee or contra�ll�
Address of mortgagee or contrad sellE
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d number
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number
as of Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
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If owned with someone other than spouse, indicate wilh whom.
st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sheet, city, state, ZIP
❑ Real ProPerty ❑ Mobile Home (IC G1.1
Does applipnt own property in any other I If yes, what county? I What Taxing Distrid? Has lhis deduction been requested on
counry in Indiana? property for curtent yeaf? 0 Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 (�� 20 20 a_r 20
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Signature County Auc
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Date
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���/ We ceAify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
�'�sident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person