HomeMy WebLinkAboutMortgage_Marvell�`���' i STATEMENT OF MORTGAGE OR CONTRACT INDEE3TEDNESS
's'��; FOR DEDUCTION FROM,ASSESSED VALUATION t T n ip Year
: .. «. � State Form 43709 (R6 / SO6) . . . '' _
� Resoibed by Department of Loml Gwemment Finance
INSTRUCTIONS: � F:�,pn��
To be filed in person or by mail with the County Auditor of the county where the propeRy is located.
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Filing Dates: 1J Real Property: During the 12 months befo2 ,lune 17 of the year the deduction is to���t�BUNTY AUDITOR
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and Ma�ch 2 0/ the year the deducUon is to be effective.
See reverse side for additional instructions and qualifications.
Applicant (owner or contract er - see restrictions on 2verse side
Taxing Dislrid Key number / legal description Record numb
� �/o '/�oO. ��/^G�� Page number
- T
Assessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is the ap�
March 1, current year March 1, current year owneR
�
t the sole legal or equitable
❑ Yes ❑ No - "`
16 no, what is his / her exad share of interesl? � If owned with someone other lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in queslion:
❑ Real PropeAy ❑ Mobile Home QC 61.1-�
�me of moAgagee or contrad seller
m I� : C3. .. �. �. n�a 07 -S44&
P����c of.moRaagee or conVad seller (number and st2et, city, state, ZIP
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/�1
{�1�1 �Q.t��.eLQ.
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counry in Indiana?
Deduction approved in the amounf of:
20�� 20�
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Signature
:gage
ZIP
what county? I What Taxing Distrid?
COUNTY AUDITOR
20 20 20
County Auditor
Has this dedudion been requested on
property for current year? � Yes ❑ No
20
Date
20
We certify under the penalty of perjury lhat the above and foregoing informalion is true and correct and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duty executed Power of Ariomey
or by IC 6-1.1-12-.W
ru�reslaem atltlress of appliwni ' Address of aulhorized person
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