HomeMy WebLinkAboutMortgage_Rice`O R�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- � FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S J S�ate Fofm 43709 (R41 70-01)
Prescribed by Depariment of Local Govemment Finance
�TRUCTIONS: F
To be filed in person or by mail with the County Auditor o/ the county where the property is located.
ANi� ���2
Filing Dates: 1) Real Property: During the 12 months be%re May 11 0/ the year the deduction is to be�ffecfive.� �/ �
2) Mobile Homes assessed under IC 6-1.1-7: 8ehveen January 15 and March 31 of the , ar the tled�cti� b��ive.
��/JJ�I�I�I �� '/ .
See 2verse side (oradditional rnstructions and qualificafions. 'O SieSON COUiJTY 0.UDITOR �
Applicant (owner or cont t buyer - see rest " ns on reverse side)
Taxing Distrid Key number / legal description , Record number.
��- _. �.o - - .3a
_ O _ Page number
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 1, current year owner? ❑ Yes ❑ No
��
If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
ne of moRgagee or contraIX seller
1 .
ress of mortgagee or contrad selier (number street, city, state, ZIP
7 %—����
Name of assignee or other owner or holder of mortgage "
�
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo �� � zo U 2o Q� 20 � zo O- zo �2 zo �
� s %!�-o�v b� �°
Signature County Auditor Date
'' We certify under the penalty of peryury that the above and foregoing informalion is true and corred and thal the applicants was / were
asident of Indiana and owner of the aforementioned property on March 1, 20
at (o s ll me) Person authorized by duly executed Power of Atlomey
or by IC 6-1.1-12-.07
F r ident address of applicant Address of aulhorized person
%�e S S�rP�