HomeMy WebLinkAboutMortgage_Johnson (13)r\'?i
y��.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fotm 43709 (R4 / 70-01)
Prescribetl by DeOartment of Local Govemment Finance
�TRUCTIONS:
To be filed in person or by mail with the County Auditor of fhe county where the property is locafed.
Filing Dates: 1) Real Praperty: During the 12 months beto2 May 11 of the year the deduction is to 6e e(fecti�Aft � U 2�0f�3
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the year the deduction is o e effective.
See reverse side (or additional instiuctions and quali(cations.
Applicant (ow^ orcontract buyer- see
Taxing Distrid
���
on ieverse
Key number / legal
'�
OVII
13��-
�-J
Record number
Page number
Assessed value of reai property as of Mortgage / Contrad indebtedness unpaid as ot Is the applicant the sole legal or equitable
March 1, curtent year March 1; current year ownef? ❑ Yes ❑ No
S$. �
If no, what is his / her exact share of
name on record is different ihan that of applicant, indicate below:
I( owned with someone other than spouse, indicate with whom.
❑ Real Properry ❑ Mobile Hmie (IC Cr1.
of mortgagee or contrad seller
of mortgagee or contract seller (number and streef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and sheet, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for arrent year? Q Yes❑ No
Deduction approved in the amount of:
2� 20 �� 20
o •
Signature
COUNTY AUDITOR
20
-�
County Auditor
20 0 l 20 _�� 20 �/
P p P
Date
/ We certiy under the penalty of peryury that the above and foregoing infortnation is true and correct and that the applicanls was / were
�resident of Indiana and owner of the aforementioned property on March 1, 20
(owners lull n
A �
Person aulhorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
oTauthorized person