HomeMy WebLinkAboutMortgage_Miller (37)i�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE '
��FOR DEDUCTION FROM ASSESSED VALUATION - Coiym� a 5 hip Year
+ State Form 43709 (R6 / SO6) �! � � �
Presaibed by Deparlmenl of Lopl Gwemment Finance
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INSTRUCTIONS: ��File Mark
To be (iled in person or by mail with the CountyAuditor of the county whe�e the property is located���
Filing Dates: 1) Real Property: Dunng the 12 months be%ie June 11 of the year the deductio�i�t�be �e�Ftiva.� i7tln
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be eflective.
See reverse side for addrtiona/ instructions and qualilications.
Applicant (owner contract buyer- see res ' ti ns oh erse side) •
Taxing Distrid Key number / legal descriplion Record number
- a�,�a -�s -�o�- �i, 3 �o- oas l�
,�,C�►,� � 3?� _EX� Page number 3
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Assessed value of real properiy as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
S � SOv
If no, whaf is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent than that of applicant, indicate below: Is the property in question:
❑ Real PropeAy ❑ Mobile Horne (IC Cr1.1-�
me of mortgagee or contrad seller �
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distric[? Has this dedudion been requested on
counfy in Indiana? property for currenl year?� Yes� No
COUNTY AUDITOR
Dedudion approved in the amount of:
20 � 20�_ 20 � 20 20 20 20
� � (
Signature County Auditor Date
� We certiy under the penalty of peryury thal the above and foregoing informalion is true and corred and thal ihe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
ignature (o ers (ull name) Person authorized by duly exewted Power of Attomey
or by IC 6-1.1-12-.07
ull esident address of applipnt Address of authorized person
iv 7, Lsr. P�. Ylc�o