HomeMy WebLinkAboutMortgage_Meredith,i:�
r:-r'�9�'t:.
l-iF
�!�
STATEMENT OF MORTGAGE OR CONTRACT INDI
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fortn 43709 (R3 / 16-00)
PreSaibeC N' Stete Board of Tax Commiuioners ��
� ��\�.
Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of the year the dedudion is to be effedive. See
reverse side for additional insUudions and qualfications.
FORM 5
Coun Township Year
File Mark
Applipnt nerorco ract buyer- see sUictions o verse side) -'
�
Taxing DisVid Key number / legal de 'ption Record number �
�_ J�� Q f_O� Page number �D�
�� �
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
If no, what is his ! her exad share of interest? If owned with someone other than spouse, indicate vrith whom.
If name on record is different lhan that of applicant, indicate below:
M�e of mortgagee or contrad seller
�
Address of mortgagee or conVad seller (number and sbeet, city, state, ZIP '
Name of assignee or other owner or holder of mortgage
Addressof assignee (number and street, dty, state, ZIP oode) •
Does applicant own real property in any If yes, what county? What Taxing Disirid? Has this dedudion been requested on
other county in Indiana? property for wrrent yeaR � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of.
zo 2o zo o zo e�� zo r�� so � zo � o q
�5 � � � � P
Signature County Auditor Date
e certify under the penalty of perjury that the above and foregoing infortnation is We and corred and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signatur owners full name) Person authorized by duly executed Power of Attomey
or by IC 61.1-12-.07
Full e ident ad f applipnt Address of authorrzed person
d s— cETO S�?� 7�