HomeMy WebLinkAboutMortgage_Watkins (2)�e` �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
1 FOR DEDUCTION FROM ASSESSED VALUATION o nt w i Year
`�,�� Stale Form 43709 (R6 / 5-06) '
� Presrnbed by Deparimem of Loral Govemment Finance
INSTRUCTIONS: File Mark
To be (iled in person or by mail with the County Auditor o( the county whe�e the property is locafed. �%j6�.. ,�i �
Filing Dates: 1) Real Property: Dunng the 12 monlhs before June Il of the year the deduction is [o be elfecti� pUDITOR
2) Mobile Homes assessed unde�lC 6-1.1-7: Between January 15 and March 2 0l tiiC��)�ih����c�ion �s fo be effective.
See reverse side fo� additional instructions and qualificatrons.
�or contract b�er -
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Assessed value of real property as of
March i, current year
on
� 1 Key number / legal description � Record number
no, what is his / her exact share of interest?
o � Page number � �
MoRgage / Conlrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year �� O� ownef? ❑ Yes ❑ No
� /l �..�� /
owned with sameone other than spouse, indicate with whom.
If name on record is different Ihan that of appiicant, indicate below:
�me of mortgagee or contract seller
�/�-' - I I 3 .
Address of mortgagee or conlrad seller (nu er and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address ci assignee (numbe� and street, city, state, ZIP code)
Is the property in question:
❑ Real Property ❑ Mobile Hane QC 61.1-�
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Does appiicant own property in any other If yes, what c'\R'� `�
county in Indiana? W /� ()
Vw� "�� 1
Deduction appro� ed in fhe amount of:
20
Signalure
20 � 20 ,_p�_ 20 20
T �
County Auditor
n
20
Date
dedudion been requested on
`or current yeaR � Yes� No
20
We certify under the penalty of perjury lhat lhe above and toregoing information is true and corred and lhat ihe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
atu (owners fuli na ) Person authorized by duty executed Power of Attomey
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Full resident address of applicant Address ot authorized person
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