HomeMy WebLinkAboutMortgage_McRoberts�
STATEMENT OF MORTGAGE OR CoNTRacT iNOEarF�NFCs
FOR DEDUCTION FROM ASSESSE
S J State Form 43709 (RS / 4-03)
�w
� PrescnDed by Department of Local Govemment Finance
�
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of
Filing Dates: 1) Real Properry.• Dunng the f 2 months befo�
2) Mo6ile Homes assessed under IC 6-1.1-7:
See reverse side for additional instiuctions and qualifrcatior
(owner
Taxing District
reverse side)
legal description
� ��_x�a-��_Xe]�.� v � - v
Assessed value of real property as of Mortgage / Contrad ir
March t, curtent year March 1, wrtent year
If no, what is his / her exad share of interesf?
If name on record is diHerent than thaf of applicant, indicate below:
mortgagee or contract seiier
as
Record number /�
U
Page number „
Is the applicant tf�e sole legal or equitable
owne(? (�'es ❑ No
T
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contracl seller (number and stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applipnt own property in any other If yes, what counry? l What Taxing Distric[?
county in Indiana? �
approved in the amouni of:
20 p�_ 20
�
Signature
COUNTY AUDITOR
20 � � 20 � 20 �
P
County Auditor
property in question:
al Property ❑ Mobile Hane (IC Fr1.
Has this deduclion been requested on
property for curtent yeaR � Yes ❑ No
20
Dale
�
��/ We certify under the penalty of perjury lhat the above and foregoing information is true and corred and lhat ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners full name) Person authorized by duty executed Power of Attomey
�a.. �,_. �fy�(>�n�,,,,-f orbYIC6-1.1-12-.07
of appliqnt _ IAddress of authorized person