HomeMy WebLinkAboutMortgage_EasterdaySTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNEce
' FOR DEDUCTION FROM ASSESSED VALUATION
�. � Sfate Fwm 43709 (R4 / 10-01)
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� PresuibeG by Depa�nt of Local Govemment Finante
INSTRUCTIONS:
To 6e filed in person or by mail with the County Auditor ol the county where the propeRy is located.
Filing Dates: 1) Real PropeRy: During the 12 months befo2 May 11 0l the year the deduction is Rq,t��el(�
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the year
See reverse side lor additional instnictions and qualifrca6ons. � � /
(owner or
on r�verse side)
Key nu1M%r / legal
GI3SON
number
is to be eHective.
l S-Dlo�a-da v Page number � n�,/
7 �f
Assessed value of real property as of Mortgage ontrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, curcent year March 1 ent year owneR ❑ Yes ❑ No
� / O�/V
If no, what is his / her exacl share of interest? owned with someone other than spouse, indicate wilh whom.
If name on record is different than that of applicant, indicate
of mortgagee or contrad seller
Address of mortgagee or contract seller (number and street,
assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
state, ZIP
Does applicant own property in any other If yes, what county? What Taxing District?
counfy in Indiana?
COUNTY AUDITOR
Deduction approved in the amount of:
20
Signature
20 ��
20 �� 20 �/i> 20 0
P
County Auditor
❑ Real Property ❑ Mobile Hane QC 61.1-�
Has this dedudion been requested on
property for cunent yeaf?❑ Yes❑ No
20� 20
�P
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
'i resident of Indiana and owner of the aforementioned property on March 1, 20
�g re (owners ll na Person authorized by duly exewted Power of Attomey
t.L_.— �. ������ o�bY��s-,.,-,z-.o�
ident address of applicant ' Address of authorized person
I/!3 v,�.� �.