HomeMy WebLinkAboutMortgage_McGillem (9)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
i / Sta;e Form 43709 (RS I a-03) . . . . . � � � ' . —1 � � � �
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� PiesaiDed by Departmeni of Locai Govemment Finance e ��
INSTRUCTIONS:
MAY 5 20�� r„ta�
To be (led in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real Property: During the 12 months belore May 11 0/ fhe year the deducti�s to be e(lective�j ' �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March.2?af tife'y E'a�r, he`deduotion� ta be eHective.
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See reverse side for additional instructions and qualifications.
Applicant (owne contract 6uyer - see restrictions on revers� ide)
Taxing Distrid , ey number / lega� description Record number O
�,^ D � _ � �06� ^ ,�.,a Page number
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Assessed value of real property as of Mortgage / ContreG indebtedness unpaid as of Is the applicant the so e legal or equitable
March 1, wrrent year March 1, wrrent ye2r owneR ❑ Yes ❑ No �
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Ii no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan thal of applicant, indicate be(ow: Is the property in question:
� ❑ Real PropeAy ❑ Mobile Home (IC 6�1.1-�
�ame of mortgagee or contraIX seller �i �
Address of mortgagee or contract seller (number and street, city, state. ZIP ,
Name of assignee or other owner or holder oi mortgage
Address of assignee (number and street, city, state, ZIP code) . -
Does applicant own property in any ether I I; yes, what co!iNy? I l�Jhat Taxing District? Has this deduction been requested on
county in Indiana? property for wrrent year?Q Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 0� zo �� � zo �� ze �� zo o�_ zo zo
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Signature County Auditor Date
�/ We certiy under the penalty of perjury that the above and foregoing information is true and corred and lhat the applicants was / were
, resident o( Indiana and owner of ihe aforemertioned property on March i, 20
Si ature (owners lull riame) Person authorized by duly executed Power o( Attomey
�`����i��f��� or by IC 6-1.1-12-.07
ull esideni addr s of applicant Address of authorized person
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