HomeMy WebLinkAboutMortgage_Harbison (8)�
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ / State Fwm 43709 (RS / 4-03)
PrescnbeA Dy Department ol Local Govemment Finance
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RUCTIONS: � � � :File Mark` F
filed in person or by mail with the CountyAuditor of the county where the property is located. ll �.e! s_f ��
Filing Dates: 1) Real PropeRy: During fhe 12 months be%re May 11 0l the year the deduction is to 6e el%ct�' n
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year therdedtict�on is�d�� eNective.
See 2verse side for additional instructions and qualifications.
or contract
Assessed value of real property as of
March 1, current year
If no, what is his / her exact
If name on
side)
Key number / tegal description
�Iq-bl'i) o -oa
Mortgage / Contract indebtedness
March 1, current year
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than that of applicant, indicate below:
of mortgagee or contrect seller
Page
unpaid as of
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Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
of mortgagee or contract seller (number and stree[, city, state,
assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state. ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District?
counry in Indiana?
20�'�
Signature
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amount
COUNTY AUDITOR
20 20 � 20
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County Auditor
sthe property
❑ Real Property ❑ Mob�le Home QC E1.1-7)
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Has Nis deduction been requested on
propertyforcurtentyear? ❑ Yes� No
20
�%
20
/ We certify under the penalty of perjury that the above and foregoing information is true and corcect and that the applicants was / were
1-esident ot Indiana and owner of the aforementioned property on March 1, 20
Person authorized b}
or by IC 6-1.1-12-.07
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