HomeMy WebLinkAboutMortgage_Luthrt�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
;c FOR DEDUCTION FROM ASSESSED VALUATION
y° > State Form 43709 (Ra I 10-07)
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� PrescribeG by DepaNnent of Local Govemment Finance
INSTRUCTIONS:
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To be filed in person or by mail with fhe County Auditor of the county whe� the property is located.
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0/ the year the deduction is f e eHective. ///I �//�
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 0/ e ear tAe�gduch .is�t2"�B'e-�Bective.
See reverse side (oradditional instructrons and quali�cations. G1350N C�JUNSY AUD�TOR 1
Appticant (ov or contract 6uyer L� rebtrjctions on 2verse side)
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Taxing Distrid Key number / legal description Record 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 equitable
March 1, current year March 1, current y r ownef? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned wilh someone other than spouse, indicate with whom.
If name on record is different ihan ihat of applicant, indicate below: Is the oronertv in auPSfinn
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�Name of mortgagee or contraIX seller � ` Drawer NO....... r..........
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Address ot mortgagee or contrad seller (n ber and street, city, state, ZIP Card NO . .....................
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduGion been requested on
county in Indiana? property for wrrent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and thal the applicants was / were
� resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur�.(�vn�s full name) �� Person authorized by duly execuled Power of Attomey
vor by IC 6-1.1-12-.07
F II resident address of applipnt Address of authorized person
(r�'7 /Y�il�em, �c�P•
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