HomeMy WebLinkAboutMortgage_Haynes (2)�
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (RS / 4-03)
PrescriEed by Departmem o1 Loral Govemmeni Finance
INSTRUCTIONS:
To be filed in person or by mail witb the CounryAudiror o/ the counry where the property is located ' 1�03
Filing Dates: 1J Real Property: During the 12 months betore May 11 0/ the year the deduction is to be eltective. �� �=. �
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 0/ the year the.deduction is to 6e effective.
See reverse side for addifional instructions and qua/�cations. �� �
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Applicant (owner or co t buyen- see restri ions on rse�sid ) •
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Taxing Dis 'IX K umber / legal descripti Record number ��
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Assessed value of real property as of MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year 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 wnom.
If name on record is diHereni than that of applicant, indicate below: Is the property in quesfion:
❑ Real Property ❑ Mobile Home QC E1.1-�
�me of mortgagee or contrad seller ,^
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Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
counfy in Indiana? property for wrrent yeaf? 0 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 �� 20 � 20 �� 20 20 20
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Signature County Auditor Date
�'/ We certify under the penalty of peryury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
I' nature (owners Iull name Person authorized by duly executed Power of Attomey
1� (t," � or by IC 6-1.1-12-.07
Fuil esident addr s of applicant Address of authorized person
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