HomeMy WebLinkAboutMortgage_Hedge (2)�. .,.no
` j.
�
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION .
State Fwm 43709 (R3 / 70-00)
Prescribed by Swte Boab of Ta�c Cortunissiotrers
��
Count Township Year
File Mark
Instructions for filing:
To be filed in person or by mail with the County Auditor of the counry where the property is �����
located during the 12 months before May 11 of the year the deduction is to be effedive. See
reverse side for additional instrudions and qualifications.
DEC 05 2001
Appiican ow er or contract er se restrictions on 2verse side)
C�/ �
Taxing ' trid Key number / legal description �
� O/n_Q//'i�_� Page number ��
y d
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the appiicant the sole legal or equitable
March 1, curtent year March 1, curre ye owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other.than spouse, indicate with whom.
If name on record is different lhan that of applicanl, i dic e below:
of mortgagee or contract seller
Address of mortgagee or contred seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own real property in any If yes, whal county? What Taxing District? Has this deduction been requested on
other wunty in Indiana? property for current year?❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
�
zo �� zo �,� zo ��/ zo � zo zo o � zo ��
,S � � P �'
Si ature �9 CountyAuditor Date
�
�e certify under the penalty of perjury that the above and foregoing information is irue and correct and that lhe applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners lull name) Person authorized by duly executed Power of Attomey
J or by IC 6-1.7-12-.07
Full resident address of plicant Address of authorized person
S. St ri o lAr `% 6 �