HomeMy WebLinkAboutMortgage_McGillem (11)..,,; .
S j
u�.
.�
. . , �� �` � �_ .. .
;— --- _:-. -
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �
FOR DEDUCTION FROM ASSESSED VALUATION ! Coun Township Year
Slate Form 43709 (Ra I 70.01) y'— ---
Prescribed by Depariment ol Local Govemment Finance
INSTRUCTIONS: � Fi M k
To be filed in person or by mail with the County Auditor of the county whe2 the property is cate� ��.-1
Filing Dates: 1) Real PropeAy: During the 12 months belore May 11 o)the year the deduchon is to be effective�.nn
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 31 of tF�aLthe q�ao�tion is to 6e e(lective.
See reverse side (or additional instructions and qualifica6ons. \�
Applicant owneror contracf bu7{�r- see re�ons on verse side) ��/ gpN COUN'" '� '�""' '
%/ �
Taxing Disirid Key number / legal description Record number �_���
� /
/ � _ �Q � �O _ � Page number
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March t, currenl year ownef? ❑ Yes ❑ No
a �06
If no, what is his / her exad share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC Cr1.1-�
e of mortgagee or contract seller ..
Address of mortgagee or wntrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicanl own property in any other If yes, what wunty? What Taxing Distrid? Has this deduction been requested on
county in Indiana? property for current yeaR� Yes� No
COUNTY AUDITOR
Dedudion approved in the amounf of:
Zo Q3._ zo zo Q� zo �i � zo �_ zo �� zo _�
o � � � �' P
Signature County Auditor Date
We certify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and thal ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
ignature (owners ame o Person authorized by duly executed Power of Attorney
� or by IC 6-1.1-12-.07
Full resident address ot appliwnt Address of authorized person