HomeMy WebLinkAboutMortgage_Leatherman (2)RR...
a � STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-a_...
if : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
'>��y Slale Porm 43709 (R4l 70-01) � [� � �
� •�.
Prescribed by Oepartnent of Local Government Finance q
OCT 16 2UO2
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Audilor o( the county where the property is loc �e ///���
Filing Dates: 1) Real PropeAy: During the 12 months before May 17 0l the year the deduction iS toube etf 've. , � �
2) Mobile Homes assessed under IC 6-1 J-7: Behveen January 15 and March 3f��� e�yJe�ar ,�, e ucGOn-, �to be ef(ective.
See reverse side for addifional inst�ucfions and qualifications.
contract 6�yer - see
Taxing Distrid
on
-,a
e side)
L% - do 1 ..�J�Jr " � a, �
Key number / legal description � Record number
I\
� � _ � � � d \ Page number �—('j I
U �a
Assessed�value of real property as of MoAgage / Contract indebtedness unpaid as of Is the applicant the so e legal or equitabie
March 1, current year March 1, current year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest?
Ii owned with someone other than spouse, indicate with whom.
If name on rewrd is diHerent than that of applicanl, indicate below:
me of mortgagee or contract seller I
� �j��
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP code)
Does applicant own property in any other I( yes, what county? What Taxing District?
county in Indiana?
Deduction approved in the amount of:
zo
Signature
COUNTY AUDITOR
2o Q� 20 �,� zo �
�
A
County Auditar
Is the property in question:
� Real Property ❑ Mobile Home pC 61.1
Has this dedudion been requested on
property for current year? �] Yes ❑ No
20 �'� 20
P
Date
zo O
We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
�sident of Indiana and owner of the aforementioned property on March 1, 20
�-' j �nature (owners (ull
or by IC 6-1.1-12-.07
executed Power of Attomey
person