HomeMy WebLinkAboutMortgage_Thomas (2)STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
-' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
t J State Form 43709 (R4170-01)
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� PrescribeA by Department W Local Govemment Finarice
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INSTRUCTlONS: � F: s� �`, �ile Mark
To 6e filed in person or by mail with the County Auditor ol the county whe2 the property is7ocate`d.`
Filing Dates: 1) Real PropeRy: During the 12 months beJo2 May 11 0/ fhe year the deduct�� i�s to 6e effe'c1 �� 'e.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 3`� of the'�y�ai�Y� deduction is to be eHective.
See reverse side /or additional inshuctions and qualifrcations.
resfricUons on reverse side)
Taxing
Assessed value of real property as of
March 1, wrrent year
no, what is his / her exact share of interest?
If name on record is different than that
mortgagee or contract seller
Key number / legal description
O /9-Z�O q �3 -o�
Mortgage / Contrad ii
March 1, currenl year
Address of mortgagee or contract seller (number and
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and street,
Does applicant own property in any
couny in Indiana?
m
Deduction approved in the amount of:
�ry��
�
i
state,
Record number
Page number
as of Is the appli�
ownef?
�S�S
t the sole legal or equitable
❑ Yes ❑ No
�O D �
If owned with someone other than spouse, indicate with whom.
below:
3 �
city, state, ZIP
If yes, what county?
Taxing Disirid?
COUNTY AUDITOR
20 O� 20 JI 20 �
P
County Audilor
❑ Real Property ❑ Mobile Home (IC 61.1
Has this deduction been requested on
property for curtent year? � Yes ❑ No
20 �
P
Date
20
We certify under lhe penalty of perjury that the above and foregoing information is lrve and corred and that the applicants was ! were
resident of Indiana and owner of the aforementioned property on March 1, 20
ie�s /ull
address
EA�
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person