HomeMy WebLinkAboutMortgage_Harris (9)e`° �'�' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
��' = FOR DEDUCTION FROM ASSESSED VALUATION
�� y Stat¢ Form 43709 (R4 / 10-07) r�
PrescnUed Dy Departnent ot Loral Govemment Finance O p
�j��/ /
INSTRUCTIONS:
Count Township Year
File Mark
To be filed in person or 6y mail wifh the County Auditor of the county where fhe propeity is located.
Filing Dates: 1) Real Property: During the 12 months be7ore May 11 0/ the year the deduction is to be effective.
2) Mo6ile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 0/ the year the deduction is to be effective.
See reverse side for additional instructions and quali�cations.
Applicanl ( ner rcontract 6uyer- see restrictions on reverse i e) .
�
Taxing Dist Key n mber / legal description Record number � D�
� �OQ� �.� Pagenumber � O�'
Assessed vatue of real property as of Mortgage / Contred indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrenf year March 1, wrrent year ownef? ❑ Yes ❑ No
`p I � I oc. s �
If no, whal is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than lhat of applicant, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobile Home (IC 61.1-�
�me of mortgagee or wnlrad selier (� � a^ �`^Q
O " � 1J�7 C.�'� � �" v \
Address of mortgagee or contract seller (number and street, city, sta , ZIP
Name of assignee or olher 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? Has this deduction been requested on
county in Indiana? property for current year?� Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo �_ zo � zo Gts' zo zo zo S$_ zo �
o�- • (� P i' f
Signature County Auditor Date
•I We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resident address of ap "cant Address of authorized person
a