HomeMy WebLinkAboutMortgage_EckertSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
` J State Fwm 43709 (R4 / 70-01)
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� Presuibe0 by Department ot Locai Govemment FinanCe
INSTRUCTIONS: File M
To 6e filed in person or by mail with the County Auditor of the county where the propeRy is located��� ��
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0l the year the deduction is to e �v
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and Maich 31 0/ th ear c n�s to be eKective.
See reverse side lor additional instnictions and quali�cations.
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Applicant (owneror ntract buyer- see restn o s on re rse si ) / —y,/,`A� E^' �V
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Ta�cing Di d Key number / legal description Record number
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Assessed value of real properly as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equilable
March 1, current year March t, cunent year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than Ihat of applicant, indicate below: Is lhe property in question:
❑ Real Properiy ❑ Mobile Home QC 61.1-�
ame of mortgagee or contract seller � ` �
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Address of mortgagee or conVad seller (number and street, city, stafe, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Ta�cing Distrid? Has this dedudion been requested on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Dedudion approved in ihe amount of:
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Signature County Auditor Date
I/ We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and lhal ihe applicants was / were
• resident of Indiana and owner of lhe aforementioned property on March 1, 20
Signat re (owners (ull name) Person authorized by duly executed Power of Attomey
��(r.�;u �� � �,`,--f or by IC 6-1.1-12-.07
Full rgsid3ent � ress Qf,a�ppli�anS+ Address of authorized person
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