HomeMy WebLinkAboutMortgage_Morrisr�::-
STATEAAENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RS / 4-03)
Coun Township Year
PrescriDed by Department of Local Govemment Finance
�INSTRUCTIONS: ,L.�{ � TFile Ma�dc'� �� �\
To be filed in person or 6y mail with the CountyAuditor of the county where the property is located. � � 1� �j—i �+�.
Filing Dates: 1J Real Property: Dunng the 12 months be7ore May 11 of the year the deduction is to be eBective. 1--� � �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ tAe year tl�e�e�u�tio�n j�sOtg� e eftective.
See reverse side for additional instructions and qual�cations. �-, � �
Appticant (owner or contract
Taxing
value of real property as of
March i, curtent year
If no, what is his / her exact share of interesl?
If name on record is different than that of
of mortgagee or contrad
Address of mortgagee or contrad seller
6ons on v e side)
Key number / legal de
o � _d
Mortgage / Contrad ir
March 1, culren�ar
�
�
ant, indicate below:
assignee or other owner or holder of mortgage
Address of assignee (number and sfreet, city, state, ZIP
Dces applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amounl of:
20 O�
U
SignaWre _
20
:ion htecor nu ber Q7� /,
V�
/ � � Page number
�dness unpaid as of Is the applicant lhe sole legal or equitable
�� owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
ZIP
What Taxing Distrid?
� COUNTY AUDITOR
20 �L 20 Q� 20
P
County Auditor
Is lhe property in question:
❑ Real Property ❑ Mobile Hortie (IC 61.1
Has this dedudion been requested on
property for current yeaf? � Yes ❑ No
20
Date
�
I/ We certify under the penalty of perjury that the above and foregoing information is true and corred and thal the applicants was / were
1 resident of Indiana and owner of the aforemenlioned property on March 1, 20
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
dent aaaress ot appiicant 0 Address of authorized person
� �%thLll�iw[: 7�w�.e���_ 6. tL�/ 'Jn