HomeMy WebLinkAboutMortgage_Moody (4)A n•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS -
' ' FOR DEDUCTION FROM ASSESSED VALUATION —� � Count �� Township Year
S' - J S�ale Form 43709 (R4 I 10-01) � �
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� Presaibed by DepartmeM ot Loa� Govemmeni Finance
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INSTRUCTIONS: (� � /�� File Mark
To be filed in person or by mail with the CountyAuditor of the county where the prop�ityi's located. �. �� �-�-��
Filing Dates: 1) Real Property: Dunng the 12 months be(o2 May 11 of the year the de�lucfiomis'to be�effeefiJe`�R
2) Mobile Homes assessed �nder IC 6-1.1-7: Behveen January 15 and Maich'31 of the year the deduction is to 6e e/%ctive.
See reverse side loradditional instructions and quali�ca6ons.
Applicant (owner or contra t buyer - see restric 'ons n erse side)
Taxing Distrid Key number / legal des li n Record number
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DO � _ ^� / / / � � Page number
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Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curcent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is difierent than that of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Mohile Hortie (IC 61.1-�
�ame of mortgagee or contrad seller
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Address of mortgagee or contract selier (number and street, city state, 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 other If yes, what county? What Taxing Distric[? Has this deduclion been requested on
county in Indiana? property for current yeaf? � Yes ❑ No
COUNTY AUDITOR
Deduclion approved in the amouni of:
20 �� 20 20 _� 20 20 20 20 �
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Signature County Auditor Date
/ We certify under lhe penalty of perjury lhat the above and foregoing infortnalion is true and corceq and thal the applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
S'W�/pature (owner's full name) Person authorized by duly exewted Power oi Attomey
/� Q_ �G or by IC 6-1.1-12-.07
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Fuil resident a dress of applicant Address of authorized person
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