HomeMy WebLinkAboutMortgage_Nixon (5)�
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ ! State Fwm 43709 (RS / 4-03)
w
P2scADeE by Depertmant ot Local Govemmem Finance
�RUCTIONS: � File Maric -
v
To 6e filed in person or by mail with the Counry Auditor of the county where the property is located. ���_�� p �^,
Filing Dates: 1) Real Property: Dunng fhe 12 months be(ore May 110l the year the deduction is to be eflectiv ' �� ��r
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0/ the year the deduction is to be effective.
See reverse side for additional inst�uctions and qualificaUons. ir� � Z 6 20�3
Applicant (owner or contra uy
Taxing Dist' `
on
Key number / legal description
' /� `_""_'�1,.u; a- <
ciasov cou,a: , „
Record number. `
Q(� _ el `-i i Q S_ Q O Page number / y� ,{`//� /
7 �� o' 'Q V °���
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? $Yes ❑ No
�D DOo.
I( no, what is his / her exact share of interest? � If owned with someone other than spouse, indicate with whom.
if name on record is difterent than that of applicant, indicate below:
me of mortgagee or contract seller
JC 1 ,E-
H ress of mortgagee or contract seller (number an s reet, city, state,
or other owner or holder of mortgage
Address of assignee (number and street, ciry, state, ZIP code)
Is the property in question:
❑ Real Property ❑ Moble Home (IC fr1.
Does applicant own property in any other If yes, what counry? I What Taxing District? Has this deduction been requested on
county in Indiana? property for curtent year? � Yes❑ No
�
Signature
COUNTY AUDITOR
amount of:
2o a� I 2o a b I zo
�
County Auditor
20 (')iS 20 O"' 20
7 �
Date
We certify under the penalry of perjury that the above and foregoing information is true and correct and lhal the applicants was! were
esident of Indiana and owner of the aforementioned property on March 1, 20
name)
of
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
person