HomeMy WebLinkAboutMortgage_Getant/; �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
��.',•. ✓ StateForm43709 (R6/5-06) �
� Presaibetl by Department of Lonl Govemment Finance
INSTRUCTIONS:
To be tiled in person or 6y mail with the CountyAuditor ol the counfy where the p�operty is located.
Filing Dates: 1) Real Property: Dunng the 12 monlhs be%re June Il of the year the deduction is to be e�q{tiv�.� .�,
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 o(the yeari{�e` d� c6on�is to be el%ctive.
See �everse side for additional instroctions and qualifications. �� ��� .
Applicant (o or contract buy�- see
�d /
Tauing D' i
���,�Z�FJ
Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interesi?
If name on record is different ihan that
of mortgagee or contract seller
Address of mortgagee or conVad seller
side)
Key number / legal description Record number
a� ia U8 �ai oaa.�a9 Page number G� �
aa � /�S
Mortgage / Contrad indebtedness unpaid as of Is the applicani the sole legal or equitable
March 1, current year owner? ❑ Yes ❑ No
Name of assignee or ofher owner or holder of moAgage
Address of assignee (number and st�eet, city, state,
owned with someone other
below:
a,�Y
city. state;
Dces apptipnt own property in any other If yes, what county? What Taxir
county in Indiana?
Deduction approved in lhe amount of:
20 �� ( 20 �_ 20
'� Q •--
I
Signature
COUNTY AUDITOR
20
County Auditor
20
spouse, indicate with whom.
Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.
a
�.� � �tt .Ql'IC . ' �I
v�~_��........
n�-:�„����.o� ,�15`� 1 .
_,
C1 C(i3F\ 5 1 i�w • ��........ ..
20
Date
20
We certify under the penalty of peryury that the above and foregoing information is true and corred and ihat the applicants was / were
resident of Indiana and owner of the aforemenlioned property on March 1, 20
Sjgnature (owners full name) Person authorized by duly ezecuted Power of Attomey �
�,.t.�- X__ .����,^,� _� 7' or by IC 6-1.1-12-.07
Full resideni address of appiicant Address of authorized person
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