HomeMy WebLinkAboutMortgage_LucasSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
t�� State Fartn 43709 (R3 / 10-00)
� PreSa�beE bY SUte Boatd ol Tax Commissbren
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Instructions for filing: .
To be filed in person or by mail with the County Auditor ot the county where tfie property is
located during the 12 months before May 11 of lhe year tlie dedudion is to be effedive. See
reverse side for additional insWCtions and qualfiqtions.
Appliprd(ownerorcont ctbuy r-see
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Assessed value of real property as of
March 1, current year
no, what is his / her exact
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Key number %
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March 1
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FORM 5
JUL 16 2001
GISSON
Record number
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ract indebtedness unpaid as of Is the applipnt the sole legal or equitable
year owneR ❑ Yes ❑ No
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If owned with someone other than spouse, indicate with whom.
If name on record is drfFerent than that of applicant, indicate below:
of mortgagee or contrad seller �/-�
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>s of mortgagee or conVad seller (number and streef, city, state, ZIP
Name of assignee or other awner or holder of mortgage
of assignee (number and street, aty, state, ZIP code)
Does applicant own real property in any I If yes, what county? I What Taxing District?
other county in Indiana?
Deduction approved in the amount
20 ���2' � rl 20 f2,�
5
COUNTY AUDITOR
20 jZ,� 20 QR�
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County Aud'Ror
20
Has this dedudion been requested on
property for wrrent yeaR ❑ Yes ❑ No
20 O',
P
Date
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certify under lhe penalty of perjury that the above and foregoing information is We and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
�q (o s fy�l name Person authorized by duly executed Power of Attomey
��/ �� �,��Q or by IC 6-1.1-12-.07
�ident addres;rpf �plipnt Address of author¢ed person
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