HomeMy WebLinkAboutMortgage_Priestly (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSED VALUATION
� / State Fam 43709 (R3l 10-00)
.a.
� P25CribeC M SUte BoarC of Tax Cortunissioners
Instructions for filing:
To be filed in person or by mail with the County AudRor of the county where the property is
located during the 12 morrths before May 11 of the year ihe dedudion is to be effedive. See
reverse side for addi�onal insWCtions and qualfipGons.
see
c
Assessed value of real property as of
March 1, current year
no, what is his / her exad
on 2verse side)
number / legal description
FORM 5
�Fi M r� �
JUL �p 2001
Record number � �
Q//)'O ��7� /rQx Page number ` � / ��
`7 / v T J �D
Mortgage / Contract indebtedness unpaid as of Is the appliqnt the sole legal or equitable
March t, wrrGen�t `ear owner? ❑ Yes ❑ No
a f7 D � C�
Ii owned with someone other than spouse, indicate with whom.
If name on record is d'rfferent than that of applicant, indicate below:
1�'� of mortgagee or contrad
�
of mortgagee or conVad seller
and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and street, aty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing Distrid?
other county in Indiana?
Dedudion approved in the amount
20 �� ' 20 �
'W l.t.l�i..'-
Signature
COUNTY AUDITOR
20 20 � 20 �
r � p
County Auditor
a
Has this dedudion been requested on
property for wrrent yeaf? � Yes ❑ No
20
Date
20 Q�p�S, �
Y P
certify under the penalty of perjury lhat lhe above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
ire (owners /ull name) . Person authorized by duly executed Power of Attomey
/ � � .� or by IC 61.1-12-.07 ..
�,.;n � ��..
�ident address of appliqnt Address of author¢ed person
.S/O Gi/,,