HomeMy WebLinkAboutMortgage_KimbroughSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
- '° FOR DEDUCTION FROM ASSESSED VALUATION
S� J SUte Form 43709 (Ra / 10.01)
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� Prescribed by DeDaM�ent ol Loc: I Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 of the year the deduction is to be effe,�(jvel 1 Z003
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and Ma�ch 31 0/ the year the deduction is to be ///e���/%ctive.
See reverse side /or additional instructions and quali�cations. r �/ /� (/
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�' GI3r,ON COJ� � v r�� ;TOR 1
Applicant (owner
Tauing
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see resMCtlons on
Assessed value of real property as of
March 1, current year
Key number / legal description
D(9 -0/� � 7
MoRgage / Contrad indebtednes
March 1, wrrent year
ecord number
Page number
as of Is the appli
ownef?
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���
� me so�e iega� or
❑ Yes ❑ No
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate low: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.
�me of mortgagee or conVad seller �� G/l� D���1I�
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/�
Address of mortgagee or contract seller (number and st�eet, city, state, ZIP-�J—��
Name of assignee or other owner or holder of mortgage
Address of a��--� / / 43 '
o� Dra�ber N�... Q 3• "e' '
cot :
....
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CardN�• ••' '
Deducuon approved in the amount of:
20 �S/
20 �,�
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�unry? What Taxing Distrid? Has this deduction been requested on
property for current yea(? � Yes ❑ No
COUNTY AUDITOR
20��Q 20Q�
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County Auditor
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20 �
P
Date
20
'/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
'resident of Indiana and owner of the aforemenlioned property on Marcli 1, 20
iignature (owners (ull na�my )� Person authorized by duly executed Power of Attomey
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reshlent addre"s� of appliqnt LJ Address of authorized person
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