HomeMy WebLinkAboutMortgage_Hardiman (2)`O� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' :� FOR DEDUCTION FROM ASSESSED VALUATION
� - j Slale Porm 43709 (R4 / 1 O-07)
PrescribeC by Department ot Local Govemmen� Finance
INSTRUCTIONS:
To be filed in person or 6y mail with the County Auditor o! the county where the property is located. �� � 4 2�02
Filing Dates: 1) Real Property: During [he 12 months be%re May 11 0! the year the deduction is to be effe
2) Mobile Homes assessed under IC 6-1.1-7: 8ehveen January 15 and Ma�ch 31 0/ the y ar the deductio �'s to be eHe ive.
See reverse side !or additional instructions and qualifications.
r,iaSON COUNTY AUDI70R
Appli t own r ar cont t buye s e restrictions o vers�e) �
Taxin ^islrid Key er / legal description Record number
U—.Fis _. Q)�,_ � J��� �/n� Page number O
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, current year owneR ❑ Yes ❑ No
y�,SDo
If no, what is his / her exact share of inleresl? I( owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC Cr1.1-�
ne of mortgagee or contraIX sell (�1.! �+'-� 1 V l
Address of mortgagee or contracl seller (number and street, city, state, ZIP
, o3-as��
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand st2et, city, state, ZIP code)
Does applicant own property in any other Ii yes, what wunry? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for wrrent yeart Q Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
� We certify under the penalty of perjury that the above and foregoing information is true and correc[ and thal lhe applicants was / were
resident of Indiana and owner of lhe aforementioned property on March 1, 20
Si ature (owners full name) Person authorized by duly executed Power of Attomey
' or by IC 6-1.1-12-.07
Full sident address of appli nt Address of authorized person
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