HomeMy WebLinkAboutMortgage_White��� , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
� ,«. > State Fwm 43709 (R6 / 5-0G)
� Presvibed by Depertment of Laal Gwemment Finance
INSTRUCTIONS:
Count Township Year
File Mark
To be filed in person or by mail with the County Auditor o! fhe county where the property is located.
Filing Dates: 1) Real Property: During the 12 months before June 17 0/ the year the deduction is to be ellective.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year the deduclion is to 6e elfective.
See reverse side for additional instuctions and qualrlications.
Appticant (ow or contra � r resMctions on reverse sid�) �
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Taxing Distric Key number! legal description Record number O
� .�"-- Page number
�` - la 1�- 0-Ooa 1? a� � SDa
Assessed value of real property as oi Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curtent year March 1, current year owner? Q Yes � No
�( 3, 6� 5 3,.5°�
IT no, what is his / her exact share oi interest? If owned with someone oiher than spouse, indicate with whom.
. oo - 3 5�
If name on record is different than that oi applicant, indicate below: Is th property in quesdon:
❑ Real Property � Mob1e Home QC G1.1-�
°' me oi moRgagee or co ct seller ,
Address of mortgagee or contract seller (number and sdeet, cify, state, ZIP
Name oi assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own property in any other Ii yes, what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year? ❑ Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20�� 20� 20 20 20 20
� �
Signature Counry Auditor Date
..I ! We certify under the penalry of perjury that the above and foregoing infortnation is true and correci and that the applicants was / were
` sident oi Indiana and owner ot the aforementioned property on March 1, 20
.. � ture (o er's full name) Person authorized by duly executed Power of Attomey
k/ b/lR� o� by ic s-�.�-�2-.0� ,
Fuli esident address oi applicant Address of authorized person '