HomeMy WebLinkAboutMortgage_Jines (7)rt�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
° FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
ti J S�ate Fortn 43709 (R4l 76-07)
�u �� Prescribe0 by Department of local Govemment Finance
iNSrRUCnoNS: MA1' � 1 2002F�ieMa`i`
To 6e filed in person or 6y mail with the County Auditor o/ the counfy whe2 the property is located.
Filing Dates: 1) Real PropeRy: Dunng the 12 months 6elore May 11 of the year the ded 'on is to 6e ffecti e.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma h 31 0/ ear� ded io to 6e eflecfive.
See reverse side /oradditional insWctions and qualifications. GIBgp��� COU ?y �;UDITOR
Applicant (ownerorco ct buyer- see 2strictions on,r�vers side)
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Tazing Distrid Key number / al description Record number
�� Page number
O/ -ce C�83 - � �
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole lega or equitable
March 1, curcent year March 1, current year owneR ❑ Yes ❑ No
,5"°� 900
If no, what is his / her exact share of inlerest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Reai Property ❑ Mobile Home pC 61.1-�
e of mortgagee or contract seller , n
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Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage ,v�/�
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Address of assignee (number and street, city, state, ZIP code) � a- 3�� Y
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Does applicant own property in any other If yes, what wunty? What Taxing DistricY? Has this deduction been requested on
county in Indiana? property for wrrent year? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amouni of:
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ign ure � County Auditor Date
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We ceAify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
.esident of Indiana and owner of lhe aforementioned propeAy on March 1, 20
n o ( full name) ., Person authorized by duty executed Power of Attomey
. or,byJC'6-1.1-12-.07
ull resident ddr ss of applipnt Address of authorized person