HomeMy WebLinkAboutMortgage_Miskell (8)� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�• ! State Form 43709 (RS / 4-03j
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� PiasdiEed by DepartmeM ol Local Govemment Finance
INSTRUCTIONS:
Coun Township Year
}L � � � ' 1
JUN F;,e M�Q04
To 6e /iled in person or 6y mail with the County Auditor of [he county where the property is located. �/
Filing Dates: 1) Real Property: Dunng the 12 months 6efore May 11 of the year the deduction is to be eflective� �� ��
2J Mo6ile Homes assessed under IC 6-1.1J: Between January 15 and Ma�ch 2 o(the year=fhe deduction%i�to be-eHective.
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See reverse side Ior additional instructions and qualifrcations.
Applicant (owner or contract b�{yer - see restricfions on reverse side)
SCC, °� Nl�r�1� l��S �
Taxing Dislrid Key number / legal description Record number� 2 O
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P`/ i���`�/� V Y7� "( �(�Q �� Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, rtent year owneR ❑ Yes ❑ No
�5$ . �Q�
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than tF�ai of applicant, indicate below: Is the property in question:
� ❑ Real Property ❑ Mobile Home (IC 61.1-n
'ame of mortgagee or contract seller
Z; b�f �-
Address of mortga e or contrad selier (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6erand street, ciry, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current yeaR � Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 � 20 G% 20 �_ 20 � 20 20
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Signature County AudRor Date
�/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
S' ature (owner /ull name) r Person authorized by duly executed Power oi Atlomey
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person