HomeMy WebLinkAboutMortgage_Hartley (3)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSED VALUATION
` - � Sfate Fotm 43709 (R4 / 10-01)
� m.
PrescribeC by Department W Lofal Govemment Finante
Year
1 gg �� �
INSTRUCTIONS: A File[pl�rk�'n�
To be filed in person or by mail with the County Auditor of the county where the property is located. �� 1�•.J
Filing Dates: 1) Real Property: Dunng the 12 monfhs be%�e May 11 of the year the deduction is to be eH�kvp. ,... u��
2) Mobile Homes assessed under IC Sf. f-7: Between January 15 and Ma�ch 31 0! the yea Ite`fledutti o be effective.
See ieverse side for additional instrucGons and qualifications. � ,/J
Applicant (owner
Assessed value of real property as of
March 1, current year
no, what is his / her exact share of interesl?
on
Key number / le�l description
�/� -U'Sa3
MoAgage / ConVad indebtedn
March 1, currenl year
Record number O
� Page number �
unpaid as of Is the applipnt the sole legal or
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is different than that of appticant, indicate below:
�me of mortgagee or contrad seller
Address of mortgagee or conVad seller (number and street, , state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and strtet, city, state, ZIP code)
Dces applicant own property in any other I If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 � I 20 �3_ I 20 �
Taxing District?
COUNTY AUDITOR
20 � I 20
Signature D�% County Auditor
s the property in question:
❑ Real Pioperty ❑ Mobile Home QC 61.1
Has this dedudion been
property for curreM year
20 � 20
P
Date
iesrea on
Yes ❑ No
We certify under lhe penalty of perjury that the above and foregoing infortnation is true and correcl and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
or by IC 6-1.1-12-.07
u. 6/,_�.i tt. f;_,..�__ i� v
executed Power of Attomey
person