HomeMy WebLinkAboutMortgage_Salemiee �,
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STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RS / 4-03)
Coun Township Year
i� PrasrnDed by Department of Local Govemment Finance ��� �F .
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor of the county whe2 the property is located. D E C 1 O Z��Mark
Filing Oates: i) Real Property.• During the 12 months before May 11 olthe year the deduction Is.to 6e effective� �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deduction is�to 6e� e/fective.
See reverse side for additional instructions and qualificafions. �� `'��^ ��"
GIBSO�! COUt11'r :.UDITO�
orconhact6uyer-see
tix.Pr- S d' I
Taxing District
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Assessed value of real property as of
March 1, current year
no, what is his / her exact share of interest?
on reverse side)
Key number / legal
D 1 R -Da ( �a-�o �
rtgage / Contract indebtedness unpaid as of
March 7, current year
number
Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
V I
If owned with someone other than spouse, indicate wiih whom.
name on record is different than that of applicant, indicate below:
of mortgagee or contrect seller
ot mortgagee or contract seller (number and street, city, 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?
county in Indiana?
)eduction approved in the amount of:
zo o zo �5 zo
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COUNT
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County Auditor
s the prapeAy
❑ Real Property ❑ Mobile Home (IC 61.1-7)
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0
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�en requested on
�ar? � Yes❑ No
I 1 We certify under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
�:sident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person