HomeMy WebLinkAboutMortgage_Hayes (3)���� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
s FOR DEDUCTION FROM ASSESSED VALUATION
S J State Fofm 43709 (R4 ! 70-01)
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� PreSCribeO by Oepartment ol Loral Govemment Finance
INSTRUCTIONS:
To be filed in person or by mai! with the County Auditor o! fhe county whe�e the property is located. F E B 2% 2�02
Filing Dates: 1) Real Property: Dudng the 12 monfhs before May 11 07 the year the deduction is to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 07 the year th�eduction is,to effecfiv .
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See reverse side !o� additional instructions and quali�cations. c.�-.�-✓�1:1
�!950N :'OU� i Y 4UDITOR
Applicant (ow r contracf b yer- see rest � fions o �verse side) �
Taxing Disl d Key number /legal description Rec number
('�i / (� � /(� / II `_/� � Page number � � I �
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Assessed value oi real property as of Mortgage / ContraG indebte ness unpaid as of Is the applicant t e s le legal or equitable
March t, curtent year March 1, current year ��� �( yC 71 owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? 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 question:
❑ Real Property ❑ Mobile Hane (IC 61.1-�
:e of moAgagee or contrad seller
Address of mortgagee or contract selier (number and stieet, city tate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
wunty in Indiana? property for cunent yeaf? � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
�
20 Q� 20 � 20 � 20 �J,� 20 20 � 20 ��'
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Sig ture B� County Auditor Date
�� We ceAify under the penalty of perjury lhal the above and foregoing information is true and correct and that the applicants was / were
sident of Indiana and owner of the aforem ntioned property on March 1, 20
Si n ner ful ) Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
F II r t address o pl cant Address of authorized person
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