HomeMy WebLinkAboutMortgage_Rodgers (2)��� � STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
"�= FOR DEDUCTION FROM ASSESSED VALUATION n 7 hi Year
��J+ State Fortn 43709 (R6 / 5-06)
� Presai6ed 6y Deperiment of Loral Govemment Finance F E 1 2 2���
INSTRUCTIONS: - ������
To be filed in person or by mail with the CountyAudito� of the county where the p�operty is located. COUNTY AUDI70R
Filing Dates: 1J Real Property: Dunng fhe 12 months before ,lune Il of the year the deduction is to b���cQi�i e.
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 and March 2 of the yea� the deduc6on is to be eHective.
See reverse side fo� additional insfructions and qual�cations.
Applican me� or contiact buyer - s sfrictlons on reve e side)
L
Taxing Distrid Key number / legal description Record number � v O D
— a�-re-a� -3oy- oov. °
� 3 a - � Page number �
Assessed value ot real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant ihe sole legal or equitable
March 1, current year March 1, currenl year ownef? ❑ Yes ❑ No
� $ 000
If no, what is his / her exad share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is diRerent than ihat of applicant, indicate below: Is the property in question:
❑ Real Property ❑ Moble Hmie QC 61.1-n
e of mortgagee or conVad seller �
— - — --.
Address of mortgagee or conVad seller (number and t2et, aty, state, ZIP j
Dra�rcr NO�Q.°.?�- � � !
........... �
Name of assignee or other owner or holder of mortgage I
i
C:ll'(� l�i� . ..................... '
Address of assignee (num6er and street, city, state, ZIP code)
Does applicant 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 amount of:
20 �� 20 �� 20 20 20 20 20
P P
Signature County Auditor Date
We certify under the penalty of peryury that the above and foregoing infortnation is lrue and corred and lhat the applicants was / were
sident of Indiana a own of the aforemenlioned property on March 1, 20
' a uc ners (ul'nam )' Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
id dre s ap lica Address of authorized person
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