HomeMy WebLinkAboutMortgage_Perry (6)e3��° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
e+«-'° .- 4 FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
�:��j State Form 43709 (R4/ 10.01) � . ,
�u.
� Prescribed by Department of Local Govemment Finance
INSTRUCTIONS: � �i � �--File.Mark
To 6e filed in person or by mail with !he County Auditor ol the county whe2 the propeity is located. �� � �
Filing Dates: 1) Real Property: Dunng the 12 months 6elore May 11 0l the year the deduction is to be-eflective.�,/ �+i
� i. �.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0l the year the deduclion is to tte�e/lective.
See reverse side for additional insWctions and quali�cations. MQR 1� 2004
�
�
♦
(owner or contract buyer - see resfnctions on reverse side)
Assessed value of real property as of
March 1, current year
no, what is his I her exact
,..�S�
Key number / legal description I Record number O�_
, �
� 1 I� Q Z��,� "" Q Q Page number
l OS6 Z
MoRgage ! Contract indebtedness unpaid as of
March 1, wrrent year
1 i11� r— n /l
If name on record is different than that ot applicant, indicate below:
Is lhe applicant the s legal or equitat
owneR es ❑ No
If owned with someone other than spouse, indicate with whom.
'ime of mortgagee or contract seller
L�`�eq� Bah K N, A,
Address ot mort gee or contrad selier (number and street, city, state, ZIP
21 S� 3�,,�,�., ��/�1 !� s Y i Tle ..1 N
Name of assignee or other ner or holder of mortgage
Atltlress oi assignee (num0er antl street, city, state, LIY COdB)
�
is tne property in quesnan:
LYReaI PropeRy � Mobile Hwne (IC 61.1
Does applicant own property in any other If yes, what county? What Taxfng Districl? I Has fhis deduciion been requested or
county in Indiana? propeAy for current year?�] Yes� N
Deduction approved in the amount of:
20 � 20 �J " 20
�
Signature
COUNTY AUDITOR
20�_ 20 D`1
� �
County Auditor
T�7
Date
20
We certify under the penalty of perjury that the above and foregoing information is true and wrrect and that the applicants was / were
resident of Indiana and owner of the aforemeniioned propeRy on March t, 20
(owners full name) �
v l�n� —�
;nt address of applicant
Person authorized by duiy executed Power of Attomey
or by IC 6-1.1-12-.07
ot authonzea person