HomeMy WebLinkAboutMortgage_Maier`�'^4�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i� FOR DEDUCTION FROM ASSESSED VALUATION Count To�mship Year
'�, State Form 43709 (R6 / 5-06)
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Presaibed by DeparVrent of Lonl Gwemment Finance
INSTRUCTIONS: � � �il a�
To be filed in person or by mail with the County Audito� o/ the county where the property is locate ��' �J ���
Filing Dates: 7J Real Property: Dunng the 12 months before June �7 0/ the year the deduction is to be efle t'K� ¢
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0! the year �fkd{iclYOrZQ�a be eflective.
See reverse side for additional instiuctions and qualifications.
Appli owner or contract buyer- see restrictions on reverse side) �_,--`.
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Taxing Disirid � Key number / legal description
�/�-�Cin�C.[��-n� � -/�3 /�'- a o3 - oo/ � 90 _o,t !
Assessed value of real property as of MoAgage / Contract indebtedness unpaid as
March 1, currenl year March 1, current year
If no, what is his / her exact share of interest?
If name on
�S p00
ihat of applicant, indicate below:
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Record number � p a 5
Page number � Q � �
I
f Is the applicant the sole legal or equitable
owne(? ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
s lhe property
❑ Real PropeM ❑ Mobile Home pC 61.1
me of mortgagee or contrad seller
(�1.�.(Z.S. �/S�,c Ca��.s��!�nYeS�r�S
Address of mortgagee or wntrad seller (number and street, city, state, ZIP -- --
Name of assignee or other owner or holder of mortgage
Address
street,
Dces applicant own property in any other If yes, what county?
county in Indiana?
Dedudion appro� ed in the amount of:
20
Signature
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Whet TBxing uumcu
COUNTY AUDITOR
20 � 20 20
P
County Auditor
..,._ ... _ �led on
property for current yeaf? � Yes � No
20
Q;
We certify under the penalty of perjury that the above and foregoing information is true and corred and that ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed
or by IC 6-1.1-12-.07
X u\\o�y a�resnor appucan[ Haoress oT aumonzea person
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