HomeMy WebLinkAboutMortgage_HaysSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSEO VALUATION
Siate Fortn 43709 (RS I a-03)
P'escnbetl by Department of Local Govemment Finarice
INSTRUCTIONS:
To 6e filed in person or by mail with the CountyAuditor of the county where the property is /ocarea:
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 0/ the year the deduction is to be e/�ect(ye{� � Z005
2) Mo6ile Homes assessed under /C 6-1.1-7: Between January 15 and March 2 0l the year�� iie7uc ion is to be eflective.
uee reve�se s�ua iw aomuvnu� �nsuucuons ano quanncauons. �
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AUDITOR
Applicant (ow er or c ntract buyer - see res 'ctions on ieverse sid )
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Taxing Dislrict Key number / legal descripti Record number
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Assessed value of real property as of Mortgage / Contrad indebledness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year �/ /f�� ownef? ❑ Yes ❑ No
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If no, what is his / her exad share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is difterent than that of applicani, indicate below: Is the property in question:
O Real PropeAy � Mobile Hort�e pC 61.1-�
�.me of mortgagee or contract seller
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Address of mortgagee or contrad seller (number and stre city, state, ZIP
Name of assignee or other owner or holder of mortgage �
Drawer NO.�:s.�. �v.7�:Z:
Address of assignee (num6er and st�eef, city, state, Z/P code)
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Card NO. �..:.:.....
Does applicant own property in any other If yes, what counry? What Taxing C s� �����������d on
county in Indiana? ��.r `� . J �� • � � No
COUNTY AUDITOR
Deduction approved in the amount of:
20 p 20 � 20 O 20 20 20 20
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Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing information is true and corred and lhat ihe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur ne/s (ull name) Person authorized by duty executed Power of Attomey
��/� or by IC 6-1.1-12-.07
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Ful ident address of applipnt Address of authorized person
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