HomeMy WebLinkAboutMortgage_WeisheitSTATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
�• J Sfate Fortn 43709 (RS / a-03)
� PrescribeC Dy Depanment o( Local Govemment Finance
INSTRUCTIONS:
To be �led in person or 6y mail with the County Auditor ol the county where the property is located. �,p I� 2004
Filing Dafes: 1J Real Property� Dunng the 12 months belore May 11 0/ the year the deduction is to �`�fective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 o he year the deduction is t� effective.
See reverse side (or additional instiucfions and qualifications. �
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Applicant (own r ontract buyer- see resMc ' s on reverse side) .
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Taxing Distrid Key number / le description Record number '/
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��,(��� oi9- o � �. ia - � Page number �� �
Assessed value of real property as of Mortgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone olher lhan spouse, indicate with whom.
If name on record is different than lhat of applicant, indicate below: Is the property in question:
❑ Real PropeAy ❑ M�ile Hm�e (IC E1.1-�
�me of mortgagee or contrad seller
Address of mortgagee or contrect seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for current year? (] Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amounf of:
zo �_ zo �� 2o D� zo �_ zo � zo zo �
6' / � � �
SignaWre County Auditor Date
�� We certify under the penalty of perjury that the above and foregoing informalion is true and corred and that the applicants was / were
resident oi diana and owner of he aforemenlioned property on March 1, 20
Signalure rs /u nam Person authorized by duly executed Power of Attomey
/ or by IC 6-1.1-12-.07
Full re ' nt address o pplicant / Address of autho�zed person
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