HomeMy WebLinkAboutMortgage_MaxeyR�° . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' : FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�, / State Fofm 43709 (R4 / 70.01)
.u.
� Prescribed by DepaMienl o/ Loral Govemment Finance
INSTRUCTIONS: �
To be filed in person or by mail with the County Auditor o( the county where the properfy is loc ��
Filing Dates: i) Real Property: Dudng fhe 12 months be7ore May 11 0l the year the deduction i e e ro �� �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 � y�r� e deducti Or� is to be eNective.
See reverse side !or additional instructions and qualifications. APR 1 2 20 �
/`
Applicant (ownerorcon buyer- see 2 triction n reverse side) `� T Y qU��S�R
�IgSON COUt�
Taxing �D/}'s/y�'d Key number / Ie al de ption Record number �O �
r i!V' ' . � / �� / �,�y� Page number ^
I � � I �J� ( W �" �
Assessed value of real properiy as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owneR 0 Yes � No
W D �0��
Ii no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicanf, indicate below: Is the property in queslion:
❑�Real Property ❑ Mo6ile Home pC 61.1-�
�me of moAgagee or contract seller ���
Address of mortgagee or contraG seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District? Has this deduction been requested on
county in Indiana? property for cunent year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounl of:
20 �_ � 20 20 20 �Z 20 20 � 20 ��
. � � �
Sig ature D� County Audilor Date
I/ We ceAity under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
��sidenl of Indiana and owner of the aforementioned property on March 1, 20
nature (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
u si en a�e�f ap ' t Address of authorized person