HomeMy WebLinkAboutMortgage_St. Clair (6)�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
��« I State Fwm 43709 (R5 / 4-03)
Prescribed by Depanment of Laal Govemmeni Finance
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RUCTIONS: � � rC Fil,e Mark, �; ;j
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� e filed in person or by mail with the County Auditor of the county where the property is located.
Filing Dates: 1J Rea/ Property: During the 12 months before May 11 0l the year fhe deduction is to be eflec`VVe. J i�,� .� �{
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year the deducfion �sGt�o 6e eflective.
See reverse side for additional instructions and qualifications. �' �/� „ i�
Applicant (owner o tract buyer - see restrictions on rev side) �
Taxing District Key number / legal description
Assessed value of real property as of Mortgage / Con ract indebtedness
March 1, current year March 1, current year
Record number � O ?
..7
Pagenumber � Q ��
7
as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
If no, what is his / her exacl share of interest? �'� � If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicale below: Is the property in question:
❑ Real Properry ❑ Mob�le Home (IC G1.
Name of mortgagee o ntract seller .
�lress of mortgagee or contract seller (number and stree city, state, ZIP
or other owner or holder of mortgage
Address of assignee (number and sVeet, city, state, ZIP code)
Dces applicant own property in any other I If yes, what counryl What Taxing District? Has this deduction been requesied on
county in Indiana? property for current year? � Yes� No
approved in the amount of:
20 �`� 20 ��
�-�-�°� �
Signature
COUNTY AUDITOR
20 D/.. � 20 O'!
County Auditor
20 �� 20 �� 20
�P P
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I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
�nature (owners full name) Person authorized by duly executed Power of Attomey
R����� �• ��� or by IC 6-7.1-12-.07
of authorized person