HomeMy WebLinkAboutMortgage_Conner (2) . v, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
;, . 1: Count FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
\ / Slate Form 43709(R4/10-01) MI L 3 1•..-.
� .
Prescribed by Department of Local Government Finance
INSTRUCTIONS: D, � 200tiie Mark
To be filed in person or by mail with the County Auditor of the county where the property is local .D /'
Filing Dates: 1)Real Property:During the-12 months before May 11 of the year the deduct'. is to bee -ctive. 17
2)Mobile Homes assessed under IC 6-1.1-7:Between January 15 and Marc s of th-' ::r he d ductiop into be effective.
See reverse side for additional instructions and qualifications. ' GIBSONCOL, +`( AUDI,OS i
Applicant(o r or ntract uu-seeae restdcfigns o erse side)
267,u i i EVA u d
Taxing Di ' Key number/legal descript Record number
)6.12A(e1) C// —W/2/0
— w Page number
D i
Assessed value of real property a as of Mortgage/Contract indebtedness btedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1.current year/r �� owner? ❑Yes ❑ No
If no,what is his/her exact share of interest? �� If owned with someone other than spouse, indicate with whom.
a` e-1 q 19-103 -000. 130-oa4
If name on record is different than that of applicant, indicate below: Is the property in question:
❑Real Property ❑Mobile Home(IC 6-1.1-7)
Jinn of mortgagee or contract seller cp,----( 5
Address of mortgagee or contract seller(num r and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street, city, state, ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on
county in Indiana? property for current year?❑Yes0 No
COUNTY AUDITOR
Deduction approved in the amount of:
20 P.2 20__01 20 0 di 20 i 9 < 20 0 (> 20 •n 7 . 20 OR
IS i Y OW P i P P
Signature A/) County Auditor Date
U-
/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was/were
esident of Indiana and owner of the aforementioned property on March 1,20
aignature(owner's full name) Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
Full resident address of applicant Address of authorized person