HomeMy WebLinkAboutMortgage_Gent,--,
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
S / Sfate Fwm 43709 (RS / 4�3)
�«
� Prescnbad by Deparirtiem of Local Govemment Finance
�RUCTIONS:
o be filed-in person or by mail with the County Auditor o1 the county whe�e the propeRy is
Filing Dates: 1) Real Property: Dunng the 12 months 6elore May 11 0/ the year the deduction is to be �CG
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l tAe year the
See reverse side !or additional instructions and qualifications. �
contract buyer - see
Asses�ed value of real property as of
March 1, current year
If no, what is his / her exact
name on
mortgagee or contract seller
2003
tion is to be
t� .,��pITOR
Key number / legal description I Record number O
D/
Mortgage / Contrect ir
March 1, pcu�rent year
/ �J IZ
applicant, indicate below:
of mortgagee or contract seller (number and street, city,
or other owner or holder oF mortgage
Address of assignee (number and sfreet, ciry, state, ZIP code)
��O O� Page number ���^
U
�btedness unpaid as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
ZIP
s the property in question:
❑ Real Property ❑ Mobile Home pC 61.
Does applicant own property in any other I( yes, what county7 I What Taxing District? I Has this deduction been requested on
county in Indiana? property for current year? ❑ Yes❑ No
approved in the amount of:
20 �!�
Signature
r� �
;�
COUNTY AUDITOR
20 _�_ 20 �`� 20 �_ 20
P �
County Auditor Da�
20
i/ We certify under the penalty of pery'ury that the above and foregoing infortnation is true and correct and that the applicants was / were
,�esident of Indiana and owner of the aforementioned property on March 1, 20
executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person