HomeMy WebLinkAboutMortgage_Anslinger`° rt�"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�4_._ Count Townshi Year
n = FOR DEDUCTION FROM ASSESSED VALUATION P —
S y State form 43709 (R4 / to-01)
�� Prescribed by DepartneN of Local Govemmen� Finance � 1' � �
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor ol the county wheie the propeRy is located. N 0 � �% Z002
Filing Dates: 1) Real Property: Dunng the 12 months belore May 11 of the year the deduction i to be effective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 � the year the de,�uclion is�to b,e elfective.
See 2verse side Ior additional instiuctions and quafifrcations.
GIp$nr.� ; �(�.`
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Applicanl (owne� or cont uyer- see restrictions on rse side) �
Taxing District ey number / legal scription Record number
) _ 1� - ��
�I� ^ 1 O_� b a�_� Page number
CJ
Assessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is�the applicant the sole legal or
March 1, curtent year March t�current year owneR ❑ Yes ❑ No
If no, what is his / her exact share of
If name on record is different than lhat of applicant, indicate below:
mortgagee or contract seller
�
;OC� I
If owned with someone olher than spouse, indicate with whom.
Address of mortgagee or contrecl seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (num6er and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what counry? What Taxing District?
county in Indiana?
SQ /a _ COUNTY AUDITOR
`
Deduction approved in the amounl of:
20
Signature
20 O� 20
GT�t[3o�
20
� �
_ County Auditor
❑ Real Property ❑ Mobile Hwne pC 61.
Has this dedudion been requested on
property for current year? � Yes ❑ No
20 C7' 1 20_
P
Date
�
certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
�(owners 11 na ) �¢. �J — Person authorized by duty executed Power of Attorney
.,. . ��_ ..�.�1�G_ �'1✓ or by IC 6-1.1-12-.07
of applic8rlt �Address of authorized person