HomeMy WebLinkAboutMortgage_McCraySTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSED VALUATION
♦ � Spte Form 43709 (R3 / 10-00)
� PresaibeE Cy State Boartl ot Tac Commissioners
Instructions for filing:
To be filed in person or by mail with the Counry Auditor of the county where the property is
located during the 12 months before May 11 of the year the deduCion is to be effedive. See
reverse side for additional insWdions and qualifiptions.
FORM 5
Coun Township Year
�
� NOV 0 �i�Q63rk
G�B/�NTY AUDITOR
Applicant (pw�eror ntract buyer :see 2stri�ns on 2versse 'de) • _. ;
V Vl/1 L
,►�-
Taxing District , Key number / legal desui ' n Recard number .(•j
ls
�'�pt� � Page number . , �
iS
Assessed value of real property as of - Mortgage / Contract indebtedness unpaid as of Is the applipnt the sole le al or equitable
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
8 � -
If no, what is his / her exact share of interest? Ii owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below:
�� of mortgagee or contrad selter �
a
Add2ss of mortgagee or contrad seller (number and et, city, at , ZIP � O � ,. ' _
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, dty. state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing DisVid? Has this dedudion been requested on
other county in Indiana? property for wrrent yeaR � Yes❑ No
COUNTY AUDITOR
Dedudian approved in the amount of:
20 � zo zo �� zo Q� zo � 7 Zo zo. o
s � �'. � �
Sig ature County Auditor Date
Ne certify under ihe penalty of perjury that the above and foregoing infortnation is We and corred and ihat the applicants was / were
ident of Indiana and owner of the aforemen6oned property on March 1, 20
Si ature (owners /u!I name) Person authorized by duly executed Power of Ariomey
�
• or by IC 67.1-12-.07
I residen ddress of app � nt Address of authorrzed person
� 16 ?D
- ------------------------------