HomeMy WebLinkAboutMortgage_Helsley ..rte:` FOR DEDUCTION FROM ASSESSED VA UATION INDEBTEDNESS County Township y�w{I1� Year
_,,'_.__,t'r State Form 43709(RU/6-09) F .-6l L Tip
Presaibed by Department of Lad Government Finance
Ale Mark
INSTRUCTIONS: I
F. 7!. 'n
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought q :aunty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Most file during the twelve(12)months
. before March 31 of each year the deduction is sought - IP' t1/J',i� .er
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See reve • •.e for additional instructions and qualificaf / / • �ITOR
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Assessed vale of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Cortract indebtedness unpaid as of Is the appli ant the sole
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March 1,current year March 1,current year date of application )/� legal or equitable owner?
Y ❑ Yes ❑ No
If no,what is his/her exam share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller d n n (�
Address of mortgagee or contract seller(number and I.city,scabs,/and ZIP a) (��
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,and ZIP code) -
Does app6 ant own property in any other If yes,what county? • What Taxing D'atrcS7 Has this deduction been requested an property .
moray in Indiana? ❑ Yes ❑ No for anent year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20
P ELS let RANDAL- scorn
Signature of County Auditor • County N/ /`
I/We certify under the penally of perjury that the above and foregoing information is 1 la and
owner l contract buyer of the aforementioned .roperty on date application is filed. /q-a(it a
SiPat;(owne WWI
Full resident address of applicant(number and street,C.-c te,and ZIP code)
�- 7ouu G/e4 .flood Of- �i fnceto�l �n / Li7‘7a
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 / Date(month,day.year) -
Address of authorized person (number and street,city,state,and ZIP code) •