HomeMy WebLinkAboutMortgage_RogersSTATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
`� FOR DEDUCTION FROM ASSESSED VALUATION
t �� StatE Form 43709 (R4 / 70-01)
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� PrescribeC by Departrrent cf Local Govemmeni Finance
INSTRUCTIONS:
Coun Township Year
Fife Mark
To be filed in person or by mail with the County Auditor ol the county whe�e the property is located.
Filing Dates: 1) Real PropeRy: During the 12 months be(ore May 11 0/ the year the deducfion is to 6e eNective.
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the year the deduction is to be eHective.
See reverse side /or additional instructions and qualifica6ons. � i �`� �j
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Appiicant (owner or contract yer - see restrictions on revers •
. .1UN 2 � 2003
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Tax' Distrid Key number / legal description Record n" ber ' �%
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I �/ 1 o a� s 3� �� Page number!�:^ .;� �.,..,._.� v� �
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Assessed vatue 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 owneR �❑ Yes ❑ No
7a�o �
If no, what is his / her exact share ot interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than ihat of appliwnt, indicale below: Is the property in question:
O Real Property ❑ Mobile Horne QC Frt.1-�
�me of mortgagee or contract seller ,
Address of mortgagee or contrad seller (number and st ,'ty, sfate, ZIP ,
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street, ciry, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year? Q Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
zo _p� zo o� zo � zo JL zo �_ 20 o y zo
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Signa ure County Auditor Date
We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
n�u (owner /ull namey'1 Person authorized by duly executed Power of Attomey
�� or by IC 6-1.1-12-.07
sident address of licant Address of authorized person
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