HomeMy WebLinkAboutMortgage_Harbison (6).S v.l:
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fortn 43709 (R4/10-01)
Prescribed by Departmenl W Local Govemmeni Finance
�TRUCTIONS:
To be filed in person or by mail with the County Audifor of the county where the property is
Filing Dates: 1) Real Prope�ty: Dunng the 12 months be(ore May 71 o/the year the deduction is to be e/�e�o'�iv�: U Luu�
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the year the dedu(c�tlon is to be el/ective.
See reverse side /or additional ins6uctions and quali�cations. �/ � /���
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Applicant (owneror n cf buyer- see res 'ons n verse si e)
Taxing istrid Key num er / legal description Record number ��
/l / „��� O /� � D /O '"7� ^� Page number /� q�J
/(�f/1 / / 00
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, cy�}�t year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is difterent than ihat of applicant, indicate below: Is the property in question:
❑ Real Pmperty ❑ Mobile Hane QC G1.1-�
"ame oi mortgagee or contraIX seller
3
Address of mortgagee or contrad seller (number and st t, city, state, ZIP
Name of assignee or other owner or holder of moAgage
Address of assignee (number and st�eet, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrent year? � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 fL� 20 D.:� 20 20 0 20 20 O
Pr�eo � I`� � � �
Signature County Auditor Date
I/ We certify under the penalty of perjury that lhe above and foregoing infortnation is true and corred and that the applicants was / were
resident of diana and owner of the aforem lioned property on March 1. 20
g ture (bwners full na Person authorized by duly executed Power of Ariomey
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� , or by IC 6-1.1-12-.07
ull r sident address of appGcant Address of authorized person
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