HomeMy WebLinkAboutMortgage_Janes;�"� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
''' ? FOR DEDUCTION FROM ASSESSED VALUATION . ou o 'p Year
. , «. �y State Form 43709 (R6l 5-06)
� Presaibed by Department of Local Govemment Finance
INSTRUCTIONS: `�j fife Maric
To be filed in person or by mail with the County Auditor of the county where the p�operty is located. v� '@��` �
Filing Dates: 1) Real Property: During the 12 months 6efoie ,lune 17 of the year the deductionqqgg� oplTOi�
2J Mobile Homes assessed unde� IC 6-1.1 J: Between January 15 and March 2 0l the yea� the deduci�on is o be eflective.
See �everse side for additional instructions and qualifications.
A licant ( wne� or�� c� e res�n� e sic�
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ing Distrid Key number / legal de ' ion Record number ,� D �-7
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o?�o-��-�a� -�Q�-QQ� ���-DaZB Pagenumber ,3 / (P i7
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is lhe applicant lhe sole legal or equitable
March 1, wrrent year March 1, wrrenl year /- owne(? � Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
It name on record is difterent than thaf of applicant, indicate below: Is the property in question:
❑ Real Properfy ❑ Mohile Home (IC 61.1-�
me of mort gee or contract seller
. ..:
Address of moRgagee o nVad seiler (number and st2et, city, state, ZIP --- _
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Name of assgnee or other owner or holder of mortgage • - f
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3 i�
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Address of assignee (number and street, city, sfate, ZIP code) Q/ jl ': f
C.IY(� 1���. . � . �IOIJ
� Dces applicant own property in any other If yes, what county? What T; �� '^ � Tj(0 ,�$� �(D � !�.ted on
counry in Indiana? •` I's� No
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COUNTY AUDITOR �
Deduction approved in fhe amounf of:
20 �_ 20 �� 20 20 20 20 20
Y 1
Signature County Auditor Date
/ We certify under the penalty of perjury lhat lhe above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Si nature (owners full name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
FUII resident a� ress of appli t Address of authorized person
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