HomeMy WebLinkAboutMortgage_White (4)��" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-' : FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S�� % Slate Form 43709 (R4 / 10-07) � �
�� PrescriDeG by Department of Local Govemment Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the property is located. ,�
Filing Dates: 1 J Real Property: During the 12 months be%re May 11 oI the year the deduction is to be��ct��
2) Mobile Homes assessed under lC 6-1.1-7: Belween January 15 and March 31 of the y he e uction�6 ective.
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See 2verse side (or additional instructions and qualifica6ons. O 20�3
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Applica t( wne orcontract buyer see restrictions on re erse side) /
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Taxing District Key number / legal description Record numbeBS� �"""
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is lhe applicant lhe sole legal or equitable
March i, current year March 1, wrrent year owne(? ❑ Yes ❑ No
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If no, what is his / her exad share of interest? If owned with someone other lhan spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mobile Home (IC 61.1-�
� ame of mortgagee or contra eller / //'/ ,/ //
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Address of mortgagee or contracl seller (number and st2et, city", tate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appticant own property in any other If yes, what couniy? What Taxing Distrid? Has this dedudion been requested on
county in Indiana? property for wrrenl yeaf?� YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 � 20 20 �� 20 � 20 �
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Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing infortnalion is true and corred and that ihe applicants was / were
�esident of Indiana and owner of the aforementioned property on March 1, 20
Signature (owners ll name) Person auihorized by duly execuled Power of Attomey
� or by IC 6-1.1-12-.07
ull resident address of applipnt Address of authorized person
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