HomeMy WebLinkAboutMortgage_Patterson�
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
�'. «� J State Fwm 43709 (RS / 4-03)
� P25cribed by Department of Local Govemmeni Finance
Coun Township Year
N � F7 Ed
�' � � �i �..�'
INSTRUCTIONS: File Mark
To be filed in person or by mail with the CountyAuditor of the county wheie the properry is located. 1�j 2�04
Filing Dates: 1) Real Properry: During the 12 months be%re May 11 0! the year the deduction is to 6e efieAp R
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0/ the year the ded �ction i's to 6e slfee6ve.
See reverse side for additional ins[nictions and qualifications. %�'�'�'`� �"`!1,v �
�- GI°_SGN�-fx���v:.U�liC'. .
Applicant (owner or contrac(
��,
Taxing Distrid
�n���o1-"r„�
Assessed value of real propE
March 1, wrtent year
- see restrictions or}�verse side)
as of
If no, what is his / her exact share of interest?
If name on record is different than thaf
of mortgagee or contract
Address of mortgagee or contrad seller
Key number / legal description Record number
oy-aG �
O��- o a � 9�' � Page number
Mortgage / Contred indebtedness unpaid as of Is the applicant,,�th/e sole legal or
March 1, current year owne(? {Q Yes ❑ No
7U o�0
If owned with someone other than spouse, indicate with whom.
indicate below:
and st2et, city, state, ZIP
Is the,Property in question:
l� Real Property ❑ Mobile Hmie
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code) Drawer NO ............:...... —
Card NO. ... � I/
Does applicant own property in any other If yes, what county? What Taxii ��"��" /� �n
county in Indiana? � ' No
v
S S .(�� � ,rj � �j COUNTY AUDITOR . _
Deduction approved in the amount of:
zo
Signature
�/l�0/Y—�IJ►��
� I /
County Auditor
zo
zo
/ We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
applicant
Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
authorized person