HomeMy WebLinkAboutMortgage_Wallace (11)� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
� � State Form 43709 (R4 ! 70-01)
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� P�escribeG by DepaNrenl W Local Govemment Finance
INSTRUCTIONS: Fite Ma '
To be filed in person or by mail with the County Auditor of the county whe2 the praperty is locate��� �,
Filing Dates: 1) Real PropeRy: During !he 12 months be%re May 11 0/ the yea� the ded�ction is t eNa�
2) Mobile Homes assessed under IC E1.1-7: Between January 15 and March 31 of the yea�thQ,ded 4[iq�,js,to be ef/ective.
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See reverse side /or additional instiuc6ons and oualifications
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App' r or con t buyer see restnction verse side) '�1 "' ,�'� �
' ,IBSOtJ COUt.TI' AUDITOR
Taui g ist d Key number / legal description Record number T( 'J
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/� ^ O � �357 , O e number �l/C
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As s ed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diBerent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
�"ame of moRgagee or conVact seller
.
Address of mortgagee or conVaIX seller (num er and stieef, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what counry7 What Tauing District? Has this deduction been requested on
county in Indiana? property for curtent yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo � zo 0 zo p�_ zo D zo Q zo �$_ 20 0
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Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnalion is true and corred and fhat the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
S n e( ers full name) Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full reside t ddress of applipnt Address of authorized person
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