HomeMy WebLinkAboutMortgage_Hardiman (5)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�'• w� ! State Fom: 43709 (R5/4-03) � . . .
� Presrnbed by Departmeni of Lo�al Gtivemment Finance �
To beR�UC�TION rson or by mail with the County Auditor of the county where the property is lo�. ���le�
Fi/ing Dates: 1) Real Property: During the 12 monfhs 6efore May 11 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the y,��hQd�li�6 is to be effective.
See reverse side for additional instnictions and qualifications.
Applicant (owner c
Taxing�
(� Iq_
�e
�as3��
Assessed value of real property as oi
March 1, cunent year
If no, what is his / her exact share of
l
� � / /I
on revArse side)
Key number / legal description Record number O�
� 1 �� • • Page number �
►
MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole egal or equitable
March 1, current year ownef? ❑ Yes ❑ No
�
If owned wilh someone ofher than spouse, indicate with whom.
name on record is diHerent than that of appiicant, indicate
mortgagee or contraIX seller
Address oi mortgagee or contract seller (number and street, city;
Name of assignee or
���u s H-alv0(�
owner or h�
ZIP
Address of assignee (number and st�ee n 1'" "�� �� �
�b�_3 -���
Does a licant own ro e in an othei �/��� . '
PP P P rtY Y � _....y,.,�.��Ct?
counry in indiana? , �
Deduction approved in the amount of:
20 _ (� i
Signatu �
20 _O�
l
COUNTY AUDITOR
20 �� 20 20
P
County Auditor
s the properiy in question:
❑ Real Property ❑ Mobile Home QC 61.
Has this dedudion been requested on
property for wrrent year? � Yes ❑ No
20
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the appiicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
nature (owners (ull name)
� -�-� �,�.. Q. � a..� '
rFesident add/re�ss of,/ap� plicant �
S�/� (� y�,y�.LD.,eO/W �t/�1
Person authorized by duly executed Power of
or by IC 6-1.1-12-.07
Address of authorized person