HomeMy WebLinkAboutMortgage_Scott (3)i i A; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°�`i' : FOR DEDUCTION FROM ASSESSED VALUATION . _ n sh . Year
J State Fwm 43709 (R6 / 5-06) �'
� Presaibed by Department of Local Gwemment Finance
INSTRUCTIONS: � �i�E Maric
To be filed in person or by mail with the County Audito� o/ the county where lhe propeRy is locafed. ���
Filing Dates: 1) Real Property: Dunng the 12 months before June I7 of the year the deduction is to ��e��NTY AUDITOR
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of t� �r lhe eduction is to be eflective.
See reverse side /or additional instructions and qualitications. �
or contrac( buyer - see
Assessed value of real property as of
March 1, curcent year
on reverse side)
Key number / legal description
d� -� a =07 . yo� - 000.
33 S—o,t8
Mortgage / Contred indebtedness unpaid as
March 1, current year
Record number /� O 7
Page number � � �
f. Is the applicant the sole legal or
owneR ❑ Yes 0 No
Co( oov
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 different than that of applicant, indicate below: Is lhe property in question:
of mortgagee or contraG seller
� �-
of mortgagee or contrad seller (number and stieet, city,
of assignee or other owner or holder of mortgage
of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deducfion approved in the amouni of:
20 �
Signature
20
I�
I ❑ Real Property ❑
�
ZIP
61.
Dra�ver NO•��� �•••""'
What T �uested on
Cal"(i�0.•�: ••�"""••••• �YeS�No
�? �i� r�:TC.4rl.,0�
COUNTY AUDITC
20 20 20
County Auditor
20
Dafe
20
certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
lenl of Indiana and owner of the aforementioned property on March 1, 20
name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
rwi e aem aaares�ppucan� � Address of authorized person
C ��� c�. �rtli4�C.r11 �rviA�
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