HomeMy WebLinkAboutMortgage_Short (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1\� FOR DEDUCTION FROM ASSESSED VALUATION
h� � State Fam 43709 (R3 ! 10-00)
�� Presuibe0 by State Board ol T� Cortunissioners
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Instructions for filing:
To be filed in person or by mail with the County Auditor of the county where the property is
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OCT 2 2 2001
FORM 5
Year
iocaieo aunny me ic monms ueiu�e may i i o� me yeai me aeuuuwn�is io oe enac�yn. oee
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reverse side for addifional insVudions and qualfiptions.
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Applipnt (o r cont2ct buyer- se�restnctions on 2verse side) - . '
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Taxing Disfid Key number / al descripUOn Record number �/
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Asseued value of real property as of Mortgage / Contrad indebtedneu unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, wrrent ye 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.
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If name on record is different than that of applicant, indicate below:
'� of moAgagee or contrad seller ,.
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Address of mortgagee or conVact seller (number and street city, state, ZIP ,
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Name of assignee or other owner or holder of mortgage /� � �
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Address of assignee (number and street, aty, state, ZIP code) '
Does appliqnt own real property in any If yes, what county? What Taxing DisVid? Has this dedudion been requested on
other county in Indiana? property for wrrent yea(? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
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Sign ture County Auditor Date
I/.We certify under the penalty of peryury that the above and foregoing information is We and corred and that the applicants was / were
ident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners lull am Person authorized by duly executed Power of Attomey
' or by IC 61.1-12-.07
ull resident addr of ap nt Address of author¢ed person
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