HomeMy WebLinkAboutMortgage_Quinn`O R�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�-° :: FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S �j State Fofm 43709 (R4110-01) � �
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� PrescribeA �y Department ot Loral Govemment Finance
INSTRUCTIONS: „pN 2 9 2 0 0 2e Mark
To be filed in person or by mail with the County Audilor o/ the county where the property is lo�ted.
Filing Dates: 1) Real Propedy: During the 12 months be%re May 11 0l the year the deductio�s to be`eff�.1/iu .
2) Mobile Homes assessed under IC 6-1.1-T Between January 15 and March 3� ��p6�lf�a e r-,fhe�deddblio'r�is to be eHective.
See reverse side for addifional inst�uctions and qualifications.
Applicant ( eror n ct byyer- see rest � tions reverse side)
Taxing Dis Key number / legal description Record number Q�
�� Q' �i _ O I O O�_OO Page number �^ I
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March t, current year owner? ❑ Yes ❑ No
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If no, what is his / her exacl share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in queslion:
❑ Real Property ❑ Mobile Home QC 61.1-�
��e of mortgagee or contrad seller
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Address of mortgagee or contred selier (number and st�et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and sVeet, city, sfate, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in indiana? property for current year? 0 Yes ❑ No
COUNTY AUDITOR
Deduclion approved in the amount of:
Zo �' zo zo � 20 �� zo � zo �_ zo Q� 09
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ign ture County Auditor Da e
�� We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
i ident of Indiana and owner of the aforementioned property on March 1, 20
Sig at re (owners full name) � Person authorized by duly executed Power of Attorney
�` , � or by IC 6-1.1-12-.07
t�'. �.
F I reside a ss a plicant Address of authorized person
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