HomeMy WebLinkAboutMortgage_Slavikrt�`° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i`�`-° � FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
'1 � Stale Form 43709 (R41 70.01)
�a.
� Prescribed by Depanment of Local Govemment Finance
INSTRUCTIONS: �� �I F{�ile M�arlc-� �� �,)
To be filed in person or 6y mail with the County Auditor o! the county whe2 the property is located. �� 11. 7t J 1Li �� ji
Filing Dates: 1) Real Property: During the 12 months 6e%�e May 11 oJ the year the deduction is to be ef(ective.
2) Mobile Homes assessed under IC 6-1. 7-7: Behveen January 15 and March 31 0/ the year the.deduc4ori is�Q� eflective.
See reverse side for additional instructions and quali�cations.
or contract
on
Taxing Dist�t Key number / legal de
7'7/,c��^� C� l g —�
Assessed value of real property as of
March t, current year
If no, what is his / her exact share of interest?
If name on record is diHereni than that
of mortgagee or contrect seller
Mortgage / Contrect i�
March 1, current year
indicate below:
Record
� /
^� Page number nO ��
7
iness unpaid as of Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
�O'v �
If owned with someone other than spouse, indicate with whom.
Address of mortgagee or contract seller (number and stieef, c1ly, state, ZIP
Name of assignee or olher owner or holder of mortgage
Address of assignee (numberand street, city, state, ZIP
Does applicant own property in any other I If yes, what counry? What Tauing Distrid?
county in Indiana?
Deduction approved in the amount of:
��lT!�tirf�3�7
E
COUNTY AUDITOR
20 Q� 20 Q �
� � .
County Auditor
s the property in question:
O Real Property ❑ Mobile Home (IC 61.1-�
Has this deduc[ion been requested on
property for current yeaf? � Yes ❑ No
20 l� 20 _
�
Date
zo�� 09
� �
certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Atlorney
or by IC 6-1.1-12-.07
resident address o� pplican�� Address of authonzed person
/ /
�'D j /�/ )c H cJ