HomeMy WebLinkAboutMortgage_Matthews"'-� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�FOR DEDUCTION FROM ASSESSED VALUATION � un nship . Year
Siate Forrt:43709 (RS I <-03)
«�
PresaiDeA hy Departmem ol Local Govemmeni Finance
� JUL 2 9
INSTRUCTIONS: File Mark
To be liled in person or by mail with the County Auditor o/ the county where the property is locate
Fi/ing Dater. 1) Real Property: Dunng the 12 months be(ore May 11 0/ the year the deduction is t�e"/�'ec roe�
2J Mobrle Homes assessed unde� IC 6-1.1•7: Between January 15 and March G4��g��(I�pgyiCdJ2pbT� to be eNective.
See reverse srde for additronal instnictions and qualifications.
Applicant (own�t,pr contract buyer- see restrictions on reverse side) �
Taxing Distrid
1�
Assessed value of real property as of
March 1, curcent year
If no, what is his / her exact
Key number / legal description Record number
D5-� � i�
QI�J ��h �� O.JM Page number
-1 CJ l.I�l
MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year ownef? ❑ Yes ❑ No
S �, VVV
If owned wifh someone other than spouse, indicate with whom.
name on record is different than that of applicant, indicate below:
of mortgagee or contraIX seller
of mortgagee or contrad seller (numbe�nd stieet, ci(y state, ZIP
Name o( assignee or other owner or holder oi mortgage
of assignee (numberand st�eet, city, state, ZIP code)
Does applicanf own property in any other If yes, what county?
wunty in Indiana7
approved in the amount of:
20 0 �
-�
Signature _
� ' ��
Taxing Dislrict?
COUNTY AUDITOR
20 O� 20 _
P
County Auditor
Ti7
,�� We certify under the penalty of peryury that the above and foregoing information
.� a residenl of Indiana and owner of the aforementioned property on March 1, 20 _
�� (owners fuU na ,
i
resident address of a[
Person autho
or by IC 6-1.1
I
Address o( au
property in question:
❑ Real Property ❑ Mobile Home (IC 61.
Has this dedudion been requested on
property for current year? [� Yes � No
20
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