HomeMy WebLinkAboutMortgage_Perry (5).,� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�• FOR DEDUCTION FROM ASSESSED VALUATION
S. J State fwm 43709 (R6! 5-06)
«.
Presvibed Cy Department of Loral Gwemmenl Finance
Counl Township Year
INSTRUCTIONS: �uLe �a0 2001
To be frled in person or by mail with the County Audito� o( the county where the property is located.
Filing Dates: i) Real Property: DuAng the 12 months before �une (1 of the year the deduction is fo be eflective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0l the yea� the de�arr�s�ective.
G�BSON ��
See reverse side for addrtional instniclions and qualifications. COUN7y qUDITOR
Applicant(ownerorconi t uyer-see
Taxing Districl
Assessed value of real property as of
March 1, curcent year
no, what is his / her exact share of interest?
If name on record is difierent than that
of moAgagee or contrad
Tions on rever e sid�)
���� �
ICey number / legal description
� -�a �� g �oi-a�a.iy�-�
Mortgage / Contrad indebtedness unpaid as
March 1, current year
� f itf� �/
indicate below:
number
�00 7
..
..
Is the applicant the sole legal or
owneR � Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Address of moRgagee or contrad seller (number and street, city, stati
Name of assignee or other owner or holder of mortgage
Address of assignee
Dces applicant own propeAy in any
county in Indiana?
Dedudion approved in the amounl of:
20�_ 20
�
Signature
state, ZIP code)
If yes, what county? What Taxin� uis[nct?
COUNTY AUDITOR
� I 20 I 20 20
County Auditor
s lhe property in questfon:
❑ Real Property ❑ Mobile Home pC G1.
9 GT, 700, 0°7_ /O -O'j
�� U,� -
�G� _`/C/J � Q O CO —
IHas this dedudion been requested on
property for wnent yeaR � Yes � No
20
Date
20
We certiy under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
�esi�nt 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
of authorized person
r ��