HomeMy WebLinkAboutMortgage_Johnson (10)�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VAIUATION Coun 7ownship Year
� �«� ! State Form 43709 (RS / 4-03) � � � �
Prescribed �y Department ol Local Govemnent Finance
INSTRUCTIONS: � � ile � �
To 6e �led in person or by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1J Real Property: Dunng the 12 months belore May 11 0l the year the deduction is to 6 ect'
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is to 6e eHective.
See reverse side lor additional instructions and qualifications. �U� 2 8 2��6
(owner
Taxing Dislrid
buyer-
Assessed value of real property as of
March 1, currenl year
If ,io, whal is his / her exact share of
�
K�ey number / legal description � Record number
db-/.2./8-.3C�0^C.Y�/•,36 D O
O�4��/';/ !^ O O Page number ��/�
� •�UQ
MoRgage / Contrad indebtedness unpaid as of Is the applicant lhe sole legal or equitable
March 1, curre t ear �`�QO owneR ❑ Yes ❑ No
✓
If name on record is different lhan that of applicant, indicate hek�w:
of moRgagee or wnlrad seller
Address of mortgagee or contrad seller (numb�'iand street,
Name of assignee or olher owner or holder of mortgage
of assignee (numberand st2et, city, state. ZfP
If owned wifh someone other than spouse, indicate with whom.
ZIP
Does applicant own property in any olh�r ! If �-..�r- F•�hat cvunty? What Taxing District?
county ir Indiana? I
COUNTY Al1DITOR
approved in the amo�int nf:--
2� �`� � 2�
� I
I
Signature
_�_
�— T 20 0� 20 20
� .__� �__ ___ ___�_
,_ County Auddor
s the property in question:
❑ Real Property O Modle Hmie pC 6�1.7-�
Has this deduclion been requested on
property for current yea(? 0 Yes 0 No
20
Date
20
We renihj under the p.�naliy of per?ury �ha� thP above and toreaoina mformaGon is true and corted and that the applicants was / were
resident of Indiana and owner of tha aforementioned property on March 1: 20
Person a��lhnrized by
or by IG 6-1.1-12-.07
of authorized person
of Nttorney