HomeMy WebLinkAboutMortgage_StevensSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� State Form 43709 (R5 / 4-03)
PrespiCed by Departmen: of �ocal Govemment Finance
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INSTRUCTIONS: ;'�' ,: }? FiI�Ma�rk
To be filed in person or 6y mail with the CountyAUditor of the counry whe2 the property is /ocated� +t � �j''�
Filing Dates: 1J Real Property: Dunng the 12 months be%re May 110/ the year the deduction is to be e8ective—.! � ��j yN
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0/ the year NUV duction is t-6E'effective.
See reverse side for additional instiuctions and qualifications. 1 4 ZQ�S
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Appli n(owneror contrac( buyer - see re ' ions� side) G;BS d �
�� ON COUNTY q�DI7pR
Taxing Dist d Key number / legal description Record number
/ O/ _OaO _ � Page number � a
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, current year March 1, cunent year owneR I�s ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diiferent than that ot applicant, indicate below: Is(�Qi/e p/roperty in question:
r.t'rT'� o....,dw._r_n.lobile Home (IC Cr1.1-�
me of mortgagee or contrad selier /� L
/`Drawer NO..........: �......
Address of mortgagee or cont�ad seller (number and treet, city, si � �„` ^ n
Card NO. ����
.....................
Name of assignee or other owner or holder of mortgage `O�S� � qy' �CQ
Address of assignee (num6er and st�eet, city, state, ZIP code) " �
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
counly in Indiana? property for current yeart � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
Zo � zo �� zo o`f Zo zo Zo zo
Y � .
Signature County Audilor Date
�/ We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
Si ature (owners (ull name) Person authorized by duly execuled Power of Attomey
/1 or by IC 6-1.1-12-.07
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Full resident ad ss of applicant Address of authorized person
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