HomeMy WebLinkAboutMortgage_Humphrey (3)STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�. «. ! State Fortn 43709 (RS I 4-03)
� PresaiDed'oy Department o7 Locat Govemment Finance
j ^-s .
�
Year
INSTRUCTIONS: �� File Maric�
To be filed in person or by mail with the County Auditor o1 the county where the property is located � '� �'
Filing Dates: 1) Real Property: During the 12 months before May 11 0/ the year the deduction is to be eff ct(ve.n 4
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year ����et7utt�o�iGs�tb be elfective.
See reverse side Ior additional insfructions and qual�cations. �` ��
.. /� / ,,..,__.. _ �. �
(owner
Assessed value of real property as of
March 1, current year
ao, what is his / her exact share of
revers� ' '
ey nu�(�� mber / legal description � Record num er �
� � � -d ��5��'007
Page numbe�a r-{/'
`�' T
MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or e
March 1, cu ent ear owner? ❑ Yes 0 No
�o O
If owned with someone other than spouse, indicate with whom.
If name on record is different Ihan lhat of applicant, indicate
moAgagee or contrad seller �
o( mortgagee or contraG seller (number and stre t, city, state, ZIP
of assignee or other owner or holder of mortgage
(numberand street, city, state, ZIP
Does appliwnt own property in any other If ves. what counry? What Taxing Distric[?
counry in Indiana?
Deduction approved in the amount of:
20�j_
Y
Signature _
20
�.
COUNTY AUDITOR
2� 20 20
�
County Auditor
Is lhe property in questian:
❑ Real Property ❑ Mobile Horne (IC G1.1
Has this dedudion been requested on
property for current yeaR �] Yes ❑ No
20
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and thal the applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
resident address of
�����
Person authorized by duty executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person