HomeMy WebLinkAboutMortgage_Pollock (3)tiA
STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
: w� ! State Fortn 43709 (RS / 4-03)
� PresaiEetl Cy Department of Local Guvemment Finance
INSTRUCTIONS: � �� �il�
To be �led in person or by mail with fhe County Auditor of the county where the property is 1 ed.�
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be e ecyvga 2p06
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o(the r e�deQduction is to be eHective.
See reverse side for additional instructions and qualifications. �
�a� _..
.,,��ma
Taxing
buyer- se�stnctjonf on
Key number / legal description ( Record number D
�/) , ^—��„ ,� �^� / n ^ D � �1, �+ � Page number �/J"�� O
_L(N I f��aCl 1 7 °` J d
Assessed value of real property as of MoAgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year owner? ❑ Yes ❑ No
L `iv `� v
If no, what is his / her exact share of interesl? If owned wiih someone olher lhan spouse, indicate with whom.
If name on record is different than ihat of applicant, indicate below: Is the property in question:
mortgagee or contract seller •
Address of mortgagee or ct�-' .
Name of assi Q •' O O
�•
�
�i
❑ Real Property ❑ Mobile Home (IC 61.1-�
�3
and st2et, city, state, ZIP
/ e`� �e
i.
9t�`` �O, ��• , LlPcode)
G`�ta
..er If yes, what counry? What Taxing Districl? Has this deduclion been requested on
property for current year? �] Yes ❑ No
Deduclion approved in the amount of:
20 �'� 20 _� $ 20 �
�_ � �
SignaWre
COUNTY AUDITOR
�
County Auditor
20
�;
Date
20
certiTy under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
full
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
resident address of�applicant' �Address of authorized person