HomeMy WebLinkAboutMortgage_Karcher (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
` � State Form 43709 (R3 / 10-00)
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—� Presrnbetl Dy State Board ol Taa Comrtussbners
InsWctions for filing:
To be filed in person or by mail wdh the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional insWCtions and qualfiptions.
,
FORM 5
Coun Township Year
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JUL 02� 200
GIB/�.Ty AUDITOR .
Applicant er or co ract buyer- see 2strictions on rev side) " ' � ..
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Taxing ''d Key number / legal description Record number /
/
Q �-0 Page number �_ , /�/ � �
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Assessed value of real property as of , Mortgage / Contrad indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March 1, curtent year March 1, cuqent year _ owneR ❑ Yes ❑ No
f5i� 0o O
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indiwte below:
�e of mortgagee or contrad seller
Address of mortgagee or contred seller (number a d street, city, state, ZIP ' .
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, dty, state, ZIP code) - • -
Does appliqnt own real property in any If yes, what county? What Tauing DisVid? Has this dedudion been requested on
other county in Indiana? property for wrrent yeaf? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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20 �_ 20 Q� 20 O 20 0� 20 20 20 _Q 7
5. . � P
Sign ture C'fi�, 0 9 County AudRor Date
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I/ We certify under the penalty of perjury that the above and foregoing information is We and corred and ihat the applicants was / were
ident of Indiana and owner of the aforementioned propeRy on March 1, 20
Si atur wne full e) Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
Full resident address of appli nt � 76�� Address of author¢ed person
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