HomeMy WebLinkAboutMortgage_Waltersrt�" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED V,�' '�-- Count Township Year
�, J Siate Fofm 43709 (R4110-01) •'
i� �•�• Prescribed by DeDartment ol Loral Gov�rRrlln�• �� __ �"� Y � .
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INSTRUCTIONS: " ' � �AK Fyl�Mark,3
To be filed in person or by mail with the County Auditor o! the county where the property is located. G �UU
Filing Dates: 1) Real Property: Dunng the 12 mon[hs 6e%re May 11 0! the year the deducfion is to be e/%ctive. �%
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and Ma�ch 31 0/ th�jyear the�de ucliofi is to he eHective.
See reverse side for additional instructions and qualifications_ � ��3S0;�� ��� p T�
Assessed value of real property as of
March 1, curtent year
no, what is his / her exact share of interest?
If name on record is differenl lhan that
mortgagee or contraIX seller
Key number / I
�
MoRgage / o
March e
Address of mortgagee or conlrad seller (number
description � Record number
, Q /\ I Page number
l.l
ad indebtednes unpaid as of Is the a
year � ��O owne(?
�;a� ; ��zi
below:
�� �
t the sole legal or equitable
❑ Yes ❑ No
It owned with someone olher an spouse, indicate with whom.
�/ - ia -oG - �t -�5�ia�s-C� �r
city. state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st�eet, city, state, ZIP code)
Does applicant own property in any
county in Indiana?
Deduction approved in the amount of:
20 .�,�
� �c.'
Signature
If yes, what county? � What Taxing Distrid?
COUNTY AUDITOR
20 Q� 20 �� 20
'P D
County Auditor
❑ Real PropetN ❑ Mobile Hort�e
Has this dedudion been requested on
property for current year? � Yes � No
20 O d 20 �
� P
Date
/ We certify under lhe penalty of perjury thal the above and foregoing infortnation is true and corred and lhat lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
(owners (yJl name)
�II resident address of applipnt
�so y Yti//� �,-od� ff
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
oi authorized person