HomeMy WebLinkAboutMortgage_Fuhrer/�,�STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Count Township .Year
� J, State Form 43709 (R6 / 5-06) .
Presaibad by �epartment of Local Gwemment Finance
INSTRUCTIONS: � a �F�rt�—�
To be (iled in person or by mail with the County Audito� of the county where the prope�ty is located. d � d
Filing Dates: 1) Real Property: Dunng the 12 months before �une 11 0/ the year the deduction is t e8�ti ��
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the deductlon is to be elfective. �
See reverse side for additional instnictlons and qualifications. N� � 0 g 2��6
Appticanl (owneror hacf buyer- ee restrictlo on reverse side) {�` w_ `
Y � Vj IB T UDITOR
Taxin triq I� d scripti n Record number
a -�o -o - b�-�o�,3y� 0 G
Q/ O�/C ��!� O' O Q Page number C Q�
( � v .�• J
Assessed value of real property as of Mortgage / ContraIX indebtedness unpaid as of Is the applicant the sole legal or equltable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
� �Q�
If no, what is his / her exad share of interest? If owned wifh someone other ihan spouse, indicate with whom.
If name on record is difterent than thaf of applicant, indicate below: Is the property in question:
❑ Real Prope�ty ❑ Moble Home QC 61.1-�
�me of mortgagee or conirad selier .
Address of moAgagee or conVad seller (number a d street, city, state, ZI
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requesled on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 � 20 � 20 Q'L 20 20 20 20
� P
Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing infortnation is lrue and correct and ihat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
gna re (owners (ull name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ull resident address of ppli nl Address of authorized person
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