HomeMy WebLinkAboutMortgage_Hathaway, �
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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS � �__
FOR DEDUCTION FROM ASSESSED VALUATION � Coun „—Township Year
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Stale Fwm 43709 (RS / 4-03) � � , � � j' �1 . � � t ' j
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PrescnDed by Depanment of Local Govemment Finance
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INSTRUCTIONS: � / � File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located � �
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Filing Dates: 1) Real Property: During the 12 montbs before May 11 of tAe year the deduction is to�be; eflective..; ^� T��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the year the deiiuction is to 6e effective.
See reverse side for additional instructions and quali�cations.
Taxing Distrid
Assessed value of real property as of
March 1, wrrent year
If no, what is his / her exact share of interesl?
Key number / legal description
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MoAgage / Contred indebtedness unpaid as
March�errent year
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If name on record is different than that of applicant, indicate be�ow:
of moAgagee or contraIX seller
number
Page number
Is the applicant the sole legal or equitable
owne(? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contrad seller (number and st2et, city, state,
Name of assignee or other owner or holder of moAgage_ .--
Address of ass1�^-� "" �
Dra�ver N�• .............. J
Does applics �l !'� (`�� (�I �
county in Indi J � !• • • • "�
Card ��• .. V .
approved in the amount of:
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What Taxing Distrid?
COUNTY AUDITOR •
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County Auditor
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propeRy in question:
❑ Real PropeAy ❑ Mobile Home QC 61.1-�
Has this deduction been requested on
propeAy for wrrent year? � Yes � No
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Date
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certify under ihe penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person