HomeMy WebLinkAboutMortgage_BushSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township� iYear
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�� / Siate Fwm 43709 (RS 14-03) t
� P25aibed by Department of Local Govemment Finance �/
JAN 15
INSTRUCTIONS: File Mark�, �
To be �led in person or 6y mail with the County Auditor oJ the county whe2 the propeRy is located. � � �-%i �
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0l the year the deduction is to be e/fective. U!�;�'�"
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2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0( the year the deduction is tb be eflective.
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See reverse side /or additional instructions and qualifications.
Applica onreverseside)
Taxing Dis ri Key number /1 g I description Record number ��
��— I � _ Page number
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Assessed value of real property as of Mortgage / Contred indebtedness unpaid as of Is ihe applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ 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 Property ❑ Mobile Home (IC G1.1-n
me of mortgagee or contrad seller
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 (numbe� and sheet, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current year? �] Yes ❑ No
COUNTY AUDITOR
Deduction approved in lhe amouni of:
20 6,f 20 20 � 20 �� 20 �� 20 20
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Signature County Auditor Date
�� We certiy under the penalty of perjury that the above and foregoing infortnation is lrue and corred and thal lhe applicanls was ! were
resident of Indiana and owner of lhe aforemenlioned property on MarcFi 1, 20
' nature owners 11 na ) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
u sident dre of applicanl Address of authorized person