HomeMy WebLinkAboutMortgage_Sullivan (8)>t:�'::r.
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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES�
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R4 / 7 P41 j
PrexribeE by Department W Lafal Govemmeni Finance
INSTRUCTIONS: �� �p� - Q, '��� ���' Y l� f_ v
To be filed in person or by mail with the County Auditor ol the county where the property is located. ("jQY i 3 2003
Filing Dates: 1) Real PropeRy: During the 12 months beJore May 11 0/ the year the deduction is to be elfective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0l the yea�.fhe ded�ucti/on isL��tjo be eN/ectiv/e/.
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See reverse side foradditional instnictions and qualifica6ons. �� ,�7�c<,.,,��
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Applicant (own r ntract uyer - see restricGons on verse side)
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Taxing Distrid Key number / legal description Record number
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{f-f ��„ O � �O 7 � r(1,.0� Pagenumber �,� �
1 l�i�" � �-� � 7
Assessed value of real property as of Mortgage / Contrad indebte ss id as of Is the applicani the sole legal or equitable
March 1, wrrent year March 1, currenl year a ownef? ❑ Yes ❑ 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 difierent ihan that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mod7e Home QC 61.1-�
' me of moAgagee or contrad seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numbe� and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county? What Taxing Distric[? Has this dedudion been requested on
county in Indiana? property for current yea(?� Yes� No
COUNTY AUDITOR
Deduction approved in the amount of:
20 � � 200 � 20 � 20 � 20 Q$_ 20 � 20
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Signature County Auditor Date
'� We ify under the penalty of perjury lhat the above and foregoing infortnation is Irue and corred and lhal the applicants was / were
e' ent of Indiana and owner of the aforementioned property on March 1, 20
i ature (owners lull name) � � Person authorized by duly executed Power of Attomey
`� or by IC 6-1.1-12-.07
Full sident add ss of licani . Address of authorized person
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