HomeMy WebLinkAboutMortgage_Wright (7)��� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION � Coun Township Year
� «. / State Fwm 43709 (R514-03) C�
� PrescnOed Oy Department of Lowl Govemment Finance `
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INSTRUCTIONS: � File Mark
To be filed in person or by mail with fhe CountyAUditor o/ the county where the property is located.
Filing Dates: i) Real Property: Dunng the 12 months before May 11 0( the year fhe deduction is fo be e/%ctive.
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 75 and March 2 of the year the deduction is to be ef(ective.
See reverse side )or additional instn�ctions and qualifications.
Applicant (owne r c trac! buyer - see r stric o vgrse si .
Ta ' ' trict y number / legal description cord number O�
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/O � �f� Pa e number 0 � �
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Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March t, wrrent year March 1, wrrent year � owner? ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than fhat of applicant, indicale below: Is the property in question:
❑ Real Property p Mobile Home (IC 6-7 J-�
�me of mortgagee or contract selier ��
Address of mortgagee or contrad seller (number and street, city, tate, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, sfate, ZIP code)
Does applicant own property in any olher If yes, what wunty? What Tazing District? Has this dedudion been requested on
county in Indiana? property for current year? � Yes❑ No
COUNTY AUDITOR I
Deduction approved in fhe amounf of:
20 �_ 20 D 7 20 �_ 20 20 20 20
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Signature Couniy Auditor Date
We certify under the penafty of perjury that the above and foregoing information is true and correct and that the applicants was / were
resident of Indiana and owner of ihe aforementioned property on March 1. 20
Signafure (owners (ull n�me Person authorized by duly executed Power of Attorney
' or by IC 6-1.1-12-.07
full sident address of a licanj-� Address of authorized person
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