HomeMy WebLinkAboutMortgage_Lythgoe�a rt�M1
/� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
°i'�= FOR DEDUCTION FROM ASSESSED VALUATION
`•...�+ State Fortn 43709 (R6 / SO6)
� Presvibetl by Department of Loml Gwemment Finance
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INSTRUCTIONS: �-y,, File Mark
To be filed in person oi by mail with the County Auditor of the county where the property is located. �'r✓� ��
Filing Dates: 7) Real Properfy: Dunng the 12 months belore June Il of the year the deduction is to b�����.6UNfiY AUBifi6�
2) Mobile Homes assessed unde� IC 6-1J-7: Between January 15 and March 2 0/ the year the deduc6on is Io'tie � ective.
See reverse side tor additional inslnicfions and qual�cations.
buyer-see
� � (
Assessed value of real property as of
March 1, curcent year
If no, what is his / her exact share of interest?
on reverse side)
Key number / legal des tion Record number
a�L -,i9-��- 3oa - ° �� � O��
�n//� Page number � `�
�s/ d
Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year ownef? ❑ Yes � No
��v�.
I owned wifh someone other than spouse, indicate with whom.
name on record is difierent ihan that of applicant, indicate below:
of mortgagee or contraIX seller
Address of moAgagee or contrad seller (number and sfreet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Is the property in question:
❑ Real Prop�rty ❑ Mobile Home QC 61.1-n
Address of assignee (number and street, city, state, ZIP code) – — - �
Does applicant own property in any other If yes, what county? uN p r���� cr N O.. Li1�/.t! �••••••• �equested on
county in Indiana? L�c � �� YesO No
✓ J
Cal'(� �'� . .. ......... .�....
couNrv,aui '� �'�� -'
Deduction approved in the amount of:
20 O/�
Signature
� • :
�
20 l J1 20 20
�
County Auditor
20
Date
�Ti7
,�/ We ceAify under the penalty of perjury thal the above and foregoing information is true and corted and that lhe applicants was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
� Signa�ure (o� rs full nam�) � Per � n authorized by duly executed Power of Atlomey
�„/-�,� ,� -�.o or b IC 6-1.1-12-.07
� Fu�r� ident�ress ��� ca� � �� nn L� y n Address of aulhorized person
y � ,