HomeMy WebLinkAboutMortgage_Wallace (14)�
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION � un ship Year
� �M� ! ' State Fortn 43709 (RS / a-03) • .
Pmscnbed by Departmeni of local Govemment Finance /
INSTRUCTIONS: Fite Mark
To be Crled in person or by mail with the County Auditor o) the county where the property is located a� ,(
Filing Dates: 1J Real Property: During the 12 months be7o2 May 11 o/the year the deduction is t�e�ctiv�
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March �l��eai�iil��ebii�%bR� to 6e eHective.
See reverse side for addilional instnictions and qualifrcations.
see restricfions on reverse
Assessed value of reat property�s of
March 1, cunent year
If no, what is his / her exact share of interest?
name on record is different than that
Name
of mortgagee or contrad
of moRgagee or contract seller
Key number / legal descrip'on
�� —� / N�� vV
Mortgage / ContraG indebtedness
March 1, current year
i
Ii owned witl
-a
znl, indicate below:
or.other owner or holder of mortgage
of assignee (numberand st2et,
Does applicant own property in any
county in Indiana?
city,
:iry, state, ZIP code)
if yes, what county?
Deduction approved in the amount of:
20 � 20 _Q� 20
i
Signature
ZIP
as
Rewrd number �
Page number � � � �
f Is the applicant the sole legal or
owneR ❑ Yes ❑ No
someone other than spouse, indicate with whom.
Olo - %�o�-�Gi,%'�'.�/-Qc��
Is the property in question:
What Taxing Distnct?
COUNTY AUDITOR
20
County Audilor
20
❑ Real Properry ❑ Mobile Home QC Crt.
52��.ce5 LLC
Has this dedudion been requested on
property for current year?� Yes❑ No
20
Dale
20
We certify under the penalty of perjury that the above and foregoing information is true and corred and that the appiicants was / were
resident of Indiana and owner of the aforementioned propeRy on March 1, 20
address
Person authorized by duly executed Power oi Attomey
or by IC 6-1.1-12-.07
of aulhorized person