HomeMy WebLinkAboutMortgage_McIntireSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
��''. � / State Fortn 43709 (RS / 4-03) ;
Prescribed by Department of Local Govemment Finance ���
INSTRUCTlONS: ' \�� File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1) Real PropeRy: During the 12 months before May 11 0! the year the deduction is to be eHecfive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year the deduction is fo 6e eHective.
See reverse side for additional instnictions and qualifications.
Applicant (own o contract buyp{- see restric ' on reve idel , "
1 �•-
Taxing Dislrid ey number / legal description Record number ��
�
O� "(J�¢\����\ Pagenumber /D�
(J�„J L:C.J
Assessed value of real property as of MoRgage / ContraU indebtedness unpaid as of Is the applicant the sole legal or equitable
March i, curcent year March 1, currenl year owner? ❑ Yes ❑ No
If no, what is his / her exact share of interest? I( owned with someone other than spouse, indicate with whom.
If name on record is diHerent than Ihat of applicanf, indicate below: Is the property in question:
❑ Real Properry ❑ Mobile Home pC 61.1-�
�me of mortgagee or contrad seller
Address of mortgagee or contract selier (number and st t, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, city, state, ZIP code)
Does appiicant avn property in any olher If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in indiana? property for current yeaR� Yes� No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 � 20 �_ 20 20. 20 20 20
P P
Signature County Auditor Date
/ W rtify under the penalry of perjury that the above and foregoing information is true and correct and that the applicants was / were
� r ident of Indiana and owner of the aforementioned property on March 1, 20
e(owners (ull name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Fu si ent address o( n Address of authorized person �
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