HomeMy WebLinkAboutMortgage_Holder (2)� �
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
++ / State Fortn 43709 (RS / 4-03)
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� Prescnbed by Department of Local Govemment Finance
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INSTRUCTIONS:
Coun Township Year
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D G �+e �� 2�03
To be filed in person or by mail with the County Auditor of the counry whe2 the property is located.
Filing Dates: 1) Real Property: During [he 12 mon[hs belore May 11 0l the year the deduction is to 6e effective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Maich 2 0/ the year the dedu� �i�� tie effective.
See reverse side for additional instrucfions and ualifications. yw`� " r '��� �`��
Q /!� GIBSOi1 COUl� �
Applirant (owner or co tract buyer - see restrictions o verse side)
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Taxing District Key n er / legal desuiption Record number D�
Q I �^ �_� Page number OD��
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Assessed value of real property as of Mortg ge / Contract indebtedness unpaid as of Is the applirant the sole legal or equitable
March 1, cunent year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? It owned with someone other than spouse, indicate wiih whom.
If name on record is diHerent than that of applicant, indicate below: Is the propeAy in question:
❑ Real Property ❑ MobOe Home (IC E1.1-7)
'�me of mortgagee or contract seller Q
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Aiidress 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 property in any other If yes, what county? What Taxing District? Has this deduction been requested on
counry in Indiana? propeRy for current year? � YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � zo o;r- 20 20 �`t zo � zo Q 9 zo
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Sig ature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and tnat the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
atu wners full name) Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ide �ess o applicant � � Address of authorized person