HomeMy WebLinkAboutMortgage_Hurst (9)' ��� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
,: FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
's��;i State Form 43709 (R4/ 70-Ot) �
ia.
PreSCribeC by Department of Local Govemment Finance '���-r ��
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INSTRUCTIONS: File Mark
To 6e filed in person or by mail wilh the County Auditor of the county where lhe p�operty is located. F E B Q v 2��2
Filing Dafes: 1J Real Prope�ty. Dunng the 12 months before May 71 of the year the deduction is-fo be ef/ective. /�
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 a�, 'th'e- y�ea�r the deduction is to 6e ef/eclive.
See reverse side /or additional instructions and quali(cations. � �i�s�^l ��-, ., � J,��m? �
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value of real property as of
March 1, curtent year
If no, whal is his / her exact share
name on record is different than lhat
of mortgagee or conVact seller
Address of moAgagee or contred seller
Name of assignee or ofher owner or
on ieverse
Key numt(�e ! legal description Record number Q�
Q � � �I � �0^� Page number D �
�
Mortgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year owner? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
indicate below:
and street,
mortgage
of assignee (numberand street, city, state, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing Distrid?
county in Indiana?
)eduction approved in the amount
20 b 20D�
ifll F� �1 •� � Y /A,/w.19'��
COUNTY AUDITOR
20 20 �� 20
i �
County Auditor
Is the
� Real Property ❑ Mobile Home pC 61.1-�
Has this deduction been requested on
property for current year? � YesO No
20� 20 (�
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Date
I/ We certify under lhe penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
,esident of Indiana and owner o( the aforementioned property on March 1, 20
(ownels full name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person