HomeMy WebLinkAboutMortgage_Richardson (4)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
S µ• / State Fotm43709 (R4/70-07) �j'
Presaibe0 by DepaRment W Local Govemment Finance � �
Y i�
TRUCTIONS: �UN �il��c
To 6e filed in person or 6y mail with the Counfy Auditor ot the county whe2 the property is located.
Filing Dates: 1) Real Prope�ty: Dunng the 12 months belo�e May 11 of the year the deduction is to�6e ef/ecfive./ �f
2) Mobile Homes assessed under IC Sl.l-7: Behveen January 15 and March 31 0/ e year the-deduction.is.to`.b�eNective.
See reverse side /or additional inshuctions and qualifications. GIBSOtJ C�OU�T Y AUDITOR �
Applicant (owner o ontract buyer- see st ctions o reverse 'de)
Taxing Distrid Key number / legal description Record number
���%' �M r—(�! � Page number
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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, curtent year March 1, current year owne(? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is diiferent ihan ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home QC 61.1-�
' me of moRgagee or contrad seller
dress of mortgagee or conUact seller (number and street, dty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has lhis deduction been requested on
county in Indiana? property for current yeaf? � Yes ❑ No
COUNTY AUDITOR
Deduction approved in lhe amount of:
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Signature County Audilor Date
/ We certify under the penalty' of perjury that the above and foregoing infortnation is true and conect and that the applicants was / were
resident of Indiana and owne� of the aforementioned property on March 1, 20
natu (owners full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full esident address of plicant Address of aulhorized person
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