HomeMy WebLinkAboutMortgage_Parker (7); e` �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
d' = FOR DEDUCTION FROM ASSESSED VALUATION
�y State Fortn 43709 (R6l 5-06) � �
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,� Presaibed by �epartment of Lopl Govemrtrent Finance
INSTRUCTIONS:
unt Trnvnship Year
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JUL' 1 1 �,?i9(d�'ark
To 6e �led in person or by mail with the County Auditor o/ fhe county whe�e the propeRy is located.
Filing Dates: 1) Real Property: Dunng the 12 months belore dune I1 0/ the year lhe deduction is to be ,!��
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of A+��pp ed� cti6jf'is to 6e effective.
� NTY AUDITOR
See reverse side for additional instructions and qualificafions.
Applicant (owner contracf buyer - see res ' ions on erse side)
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Taxing Distrid ' Key number / legal descriplion � Record number .
Page number ^
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Assessed value of real properiy as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole leg I or equitable
March 1, current year March 1, current year owne(? ❑ Yes ❑ No
y (� oz�o
Ii no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is dif(erent lhan that of applicant, indicate below: Is the property in question:
❑ Real PropeAy � Mobile Hmie (IC G1.1-�
'3me of moAgagee or conVact seller �'
Address of mortgagee or contrad seller (number and street, city, state, ZIP
Name of assignee or other owner ar holder of mortgage
Address of assignee (numbe�and street, city, sfate, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
couniy in Indiana? property for current yeaf? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 �_ 20 � 20 20 20 20 20
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Signature County AudRor Date
�'! We certi(y under the penalty of perjury that the above and foregoing information is lrue and corred and that ihe applicants was / were
esidenl of Indiana and ow er of the aforemenlioned property on March 1, 20
Si re (owne s/u�l,na e) Person authorized by duly executed Power of Attomey
e r` or by IC 6-1.1-12-.07
ull sident address f applicant Address of authorized person
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