HomeMy WebLinkAboutMortgage_Gendren"'rt�"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
"'�-° � FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
S J Slate Form 43709 (R4 / 70.01)
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PrescribeA by Departmenl of Local Govemment Finance
INSTRUCTIONS: � A IS�I�Mar�OO2
To be filed in person or by mail with the County Auditor o/ the county whe2 the property is located.
Filing Dates: 1) Real PropeRy: During the 12 months belore May 11 o/the year the deduction is to be �ctive. � � �
2) Mo6ile Homes assessed under IC 6-1.1-7: 8ehveen January 15 and March 31 of the yea�4be-deruc.' n�� eNective.
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See reverse side /or additional inst�uctions and qualifications_ •"'-.' -.,
Applicant (owner or contract 6uyer- see restnctions on reverse side)
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Taxing Oistrict Key number / legal description Record number
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Assessed value of real propeAy as of Mortgage / Contract indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year March 1, wrrent year owneR ❑ Yes ❑ No
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 differenl lhan thal of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
�e of morigagee or contraIX seller
Addr ss of mortgagee or contrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own propeRy in any other If yes, what county? What Taxing Dislrid? Has this deduction been requested on
county in Indiana? property for wrtent yeaf? 0 Yes❑ No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 20 20 �l� 20 �,� 20 20 �� 20 �
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Sig Wre County Auditor Date
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'' We certify under the penalty of perjury that the above and foregoing information is We and corred and that lhe applicants was / were
sident of Indiana and owner of the aforementioned property on March 1, 20
Signature own� ame � Person authorized by duly executed Power o( Atlorney
� or by IC 6-1.1-12-.07
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II resi ent address of applicant Address of authorized person
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