HomeMy WebLinkAboutMortgage_Kirby (3),j''A;?J
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R4/ 10-01 j
Prescribed by DepaMient of Local Govemment Finance
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INSTRUCTIONS: "" R yj
To be filed in. person or by mail with the County Auditor of the county whe2 the property is located. � ��3
Filing Dates: 1) Real Property: Dunng fhe 12 months belo2 May 11 0/ the year the deductlon is to�ef�ec6ve,� Q
2J Mo6ile Homes assessed under IC E1.1-7: Between January 15 and March 31 0l the R@ac t�he deduc s to be eff ctive.
See reverse side for additional inst�uctions and quali�cations. I c��`vTy AUDITpR
Applicant (owneror t cf 6uyer- e re ns on verse si )
Taxing Dis ' Key yan le al ¢qs�' / ecord number �
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Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitabie
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
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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, indicate below: Is the property in question:
❑ Real PmpeAy ❑ Mobile Horne QC Cr1.1-�
�me of moRgagee or conVad seller
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Address of mortgagee or contrad seller (number and street, ci , state, ZIP 0� Q
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signalure County Auditor Date
I/ We certify under ihe penalty of perjury that the above and foregoing informalion is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
ignature (ow ers 11 name Person authorized by duly executed Power of Attomey
. or by IC 6-1.1-12-.07
F( I�I resident ad ress a liqnt Address of authorized person
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