HomeMy WebLinkAboutMortgage_Milheiser (3)�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION C n w shi Year
�: M� ! State Form 43709 �RS / 4-03) J
� Prescn�ed �y Department of Loral Govemmeni Finance A P R 1 9 Q
INSTRUCTIONS: �� ��ite_Mark
To be filed in person or by mail with the County Auditor of the county whe�e fhe property is located. ��� �'
Filing Dates: 1) Real Property: Dunng the 12 months be%re May 11 0l the year the deduction is�i$��@�ffesil�TY AUDI70R
2) Mo6ile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 2 of the year the deduction is to be e!lective.
See reverse side for additional instnictions and qualifications.
(owner or contract
on reverse side) .'
number /
Record number
`(L �—� O � // p _ � Page number / 5
/ ,/ �� C�
Assessed value 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, current year . ownef? �es ❑ No
.�8��
If no, whai is his / her exact share of interest? Ii owned with someone other than spouse, indicate with whom.
If name on record is diHerent than that of applicant, indicate below: Is the property in question:
me ot mortgagee or contrad seller
Address of mortgagee or contrect sell�r (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
/
ot assignee (num6er and street, city, state, ZIP code)
Dces applipnt own property in any other I If yes, what county?
county in Indiana?
approved in the amount of:
20 �
Signalure
r� �•
PropeRy ❑ Mobile Home QC 6�1.1
Dra�ver 1'O .°�..�.�.......
Whz � 5 uested on
CBCd 1�� . .............�••••• Yes❑No
� �� �e��•
COUNTY AUDITOR
20 �D _ 20 20
� County Audifor
�
20
We certify under the penalty of perjury lhat the above and foregoing intormation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
full
.
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person