HomeMy WebLinkAboutMortgage_EstesSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun[[[jjj T�,oIwnsh1ip \\ Year
' Siate Fomt 43709 (R4 / 10-01) �, � V'� N p
�� PrescribeC by Depamrent o! Lczi Gey?mment Finance J liJ 3L%
,1uN 2 u 2003
INSTRUCTIONS: � File,Mark
To 6e filed in person or by mail with the County Auditor of the county where the property is locatecf� �� /J �
Filing Dates: 1) Real Property: Dudng the 12 months before May 11 0/ the year the deduction is t�be;etfectiv�..�q� <�-�.(,f��'
2) Mobile Homes assessed underlC 6-1.1-7: Behveen January 15 and Marcb 31 o%4he�e8�'Me',derlucGon.isi{o:6e eHective.
See reverse side !or additional instuctions and quali�ca6ons.
Applicant(ownerorcontra er s res t' n on verseside)
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Taxin trid Key number / legal description Record number A
/ U
L� o/n_ •%�/l� �% �h _/7'l Page number S3 a�8
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Assessed value of real property as of MoRgage / C ntrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, cu year owneR ❑ Yes ❑ No
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If no, what is his / her exact 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:
❑ Real Property � Mobile Hmie QC 61.1-�
me of mortgagee r contrad seiler
Address of mortgagee or contrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Dces applicant own property in any other If yes, what caunty? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yea�? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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P P � P
Signature County Audilor Date
i/ We certify under the penalty of perjury ihat the above and foregoing information is Irue and corred and that the applicants was / were
esident of Indiana and owner of lhe aforementioned property on March 1, 20
Signature (own� 11 n e) Person aulhorized by duly executed Power of Attomey
✓ �/% ' � or by IC 6-1.1-12-.07
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Full resident address of applipnt Address of authorized person
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