HomeMy WebLinkAboutMortgage_Reynolds (3)� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�+ H� ♦ State Fortn 43709 (RS / 4-03)
PrescnEed by Department of Local Govemment Finance
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TRUCTIONS:
e Fled in person or by mail with the County Auditor of the county where the property is /ocated.
Filing Dates: 1J Real Property: During the 12 months be%re May 11 0/ the year the deduction is to
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 0/ the
See reverse side for additronal instructions and qualifications.
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Appucant r or confract buyer - see re�stny�rons on reverse srde) „��� n �.'
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Taxing Dis ' t / Key number / legal description Record number O�
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of is the applicant the sole legal or
March 1, curtent year March 1, cunent year owner? ❑ Yes ❑ No
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If no, what is his / ner exact share of interest?
If name on record is different than that of
of mortgagee or contract
of mortgagee or contrect seller (number
It owned with someone other than spouse, indicate with whom.
r
street, city, state, ZIP
of assignee or other owner or holder of mortgage
Address of assignee (number and street,
Does applicant own property in any
countyinlndiana?
Deduction approved in the amount of:
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state,
If yes, what county? � What Taxing District?
COUNTY AUDITOR
20 � I 20 � 20 � 20 �
Counly Auditor
Is lhe praperty
❑ Real Properry ❑ Mobile Home (IC 61.
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Has this deduction been requested on
property for current year? 0 Yes ❑ No
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P
Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was I were
a resident of Indiana and owner of the aforementioned property on March 1, 20
or by IC 6-1.1-12-.07
address of applfcan[ Address of authorized person
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