HomeMy WebLinkAboutMortgage_Sailer (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
\ � State Form 43709 (R3 / 10-00) �
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`�� Pretvibetl by State Board o1 Tax Cortuttissioners
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Instructio�s for fiiing:
To be filed in person or by mail with the County Auditor of the county where the property is
located during the 12 months before May 11 of lhe year the dedudion is to be effedive. See
reverse side for addi�onal instructions and qualfip6ons.
FORM 5
JUL i g 2001
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Applip ( e rcont c uyer- s stri ns on reverse side)
Taxing ' trict Key number / legal description Record number J�O
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Assessed value of real property as of Martgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equdable
March 1, wrrent year March � ent year owneR ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below
"� of mortgagee or contrad seller ���
;
Address of mortgagee or contrad seller (number and street, city, state, ZIP �
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, aty, state, ZIP code)
Does applipnt own real property in any If yes, what county? What Taxing DisUid? Has this dedudion been requested on
other county in Indiana? property for current yeaR ❑ Yes ❑ No
COUNTYAUDROR
Dedudian approved in the amounf of:
20 �� 20 20 D 20 DS 20 C`%� 20 n% 20 � � _
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Signature County AudRor Date
I i we certify under lhe penalty of perjury that the above and foregoing information is W e and corred and that the applicants was / were
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ident of Indiana and owner of the aforementioned property on March 1, 20
Sig ture owners lull na ) - Person authorized by duly executed Power of Attomey
n_ Q i/� J or by IC 61.1-12-.07
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Full resident address of appliqnt Addreu of author¢ed person
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