HomeMy WebLinkAboutMortgage_Miley (7)`° rt�"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'"k-� .: FOR DEDUCTION FROM ASSESSED VALUATION
t, �> SWte FOfm 43709 (R4! 1P-01)
�a.
� Prescribed by DeDartment ol Local Govemment Finance
Township � Year
INSTRUCTIONS: � � File � �
To be filed in person or by mail with the County Auditor o( the county wheie the property is located. � 1 2 2QOZ
Filing Dates: 1) Real Property: During the 72 months before May 71 0/ the year the deduction is to be effectiv .
2) Mobile Homes assessed under IC 6-1 J-7: Between January 15 and March 31 0l the year the uction �s to be
See reverse side lor additional instiucfions and qualifications.
o� contract buyer- see re�tnctj�ns on reverse side)
Taxing Dislrict Key number % leg�l{�escription Record numb��v
\ n� U o( � - �
7" Q/ Q _� �_ Page number
� 7
Assessed v lue of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, current year March 1, currenl year owneR ❑ Yes ❑ No
O �Q
If no, what is his / her exacl share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different lhan lhat
of mortgagee or contraIX seller
Address of mortgagee or contrad selier
indicate below:
stieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand street, ciry, state, ZIP code)
�
Does applicant own property in any other If yes, what county? What Taxing Distrid?
county in Indiana?
Deduction approved in the amount of:
20 n:L 1."' I 20 !� J' I 20
S�
COUNTY AUDITOR
20 �
County Auditor
Is the property in question:
❑ Real Property ❑ Mobile Home pC Cr1.1
Has this deduction been requested on
property for cunent year? �] Yes 0 No
20 �i � I 20
Date
20
�
certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
address of a4fpl'cant � IAddress of authorized person