HomeMy WebLinkAboutMortgage_Owens (2)��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ���
�ai� FOR DEDUCTION FROM ASSESSED VALUATION ount 1 T' hi Year
,.. N� � S1ateForm43709 (R6/5-06) �
Presaibed by Depariment ol Local Govemment Finaixe N� ���oOC
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INSTRUCTIONS: �
To be filed in person or by mail with the CountyAuditor of the county where the property is /ocated��BSON C� T� OR
Filing Dates: 1J Real Property: DuBng the i2 months before June �1 oRhe year the deduction is to be eflectrve.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the year the deduction is to be effective.
See reverse side for additional instiucfions and qualifications.
(owner or contracf by�1� - see restnctions
Tauing Distrid D � � Key numberYegal description
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Record number
Page number
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Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is lhe applicant the sole legal or equitable
March 1, current year - March 1, currenl year owner? 0 Yes ❑ No
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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 that of appticant, indicate below: Is the property in question:
of mortgagee or contract seller
Address of moAgagee or contrad seller (number and stieet,
Name of assignee or other owner or holder of mortgage
of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other I If yes, what county?
county in Indiana?
approved in the amount of:
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20_ Dra�ver NO....o�..Q�.J,�Q
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Sign � y9 14a, /y
ZIP
What Taxing District?
COUNTY AUDITOR
20
y Auditor
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❑ Real Property ❑ Mohile Home pC 61.1-�
nas mis aeauaion oeen requesiea on
property for cunent year? � Yes � No
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We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
resident addr�ss of ajiplipnt � / Address of authorized person
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