HomeMy WebLinkAboutMortgage_Market (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
� � State Form 43709 (R3 / 10-00)
a..
� Presaibetl Ey Sfate BoarE o( Tax Commissiorers
Instructions for filing: '
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effective. See
reverse side for additional insWdions and qualifica6ons.
buyer-see
Assessed value of real property as of ,
March 1, current year
If no, what is his / her exad share of interest?
FOpM 5
AUG "! 0 'L001
�
Key number / legal description� Record number O/
l �
(/ /�"/ -6 3� s 3-c�D Page number O�
Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equkable
March 1, w�t year '�� � D� � owneR ❑ Yes ❑ No
SDo
If o ed with someone other than spouse, indicate with whom.
If name on record is d'rfferent than that of applicant, indicate below:
mortgagee or contrad
Address of mortgagee or conVad seller (number and stieet, city,
Name of assignee or other owner or holder of mortgage
ZIP code)
Does applipnt own real property in any I If yes, what county?
other county in Indiana?
Deduction approved in the amount
20 fJ� • 20
a�P �5 �f�„�-�
n
ZIP
What Tauing Distrid?
COUNTY AUDITOR
20�L� 20r� 5
. �
County Aud'Ror
Has this tleduction been requestetl on
property for current yeaR ❑ Yes❑ No
20 O.; � 20 O'/
Date
20
- .
certify under the penalty of perjury fhat lhe above and foregoing informaGon is true and corted and that the applicants was / were
lent of Indiana and owner of the aforemenGoned property on March 1, 20
ire (owne/s 1u11 name) Person authorized by duly executed Power of Attomey
v.n e_ �, nn A 1 or by IC 61.1-12-.07
of applicant �Address af author¢ed person