HomeMy WebLinkAboutMortgage_Heldt (4).+"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co nt hi Year
:�
FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (Re / 2-07)
��f Prescribed by Department of Local Govemmeni Finance AP R 0 3 2009
File Mark
INSTRUCTIONS: /��
To be lled in person or by mail wdh the CountyAuditor o/the county where the pmperty is loca[ed �- �%%,s� N�
Fding Dates: 7J Real Property: Dunng the 12 months be/ole June 17 0/ the year the deduc6on is to be eflective.
2) Mobile Hames assessed under IC &1.1-7: Belween January 15 and March 2 of the yeer the � i�fl�b�'��/ettti%e^.ITOR
See reverse side 7w additional �i Wctrons and puali(catrons. �
Appicant
Disiricl
legal
Assessed rdue of real popeity as af Martl� 1. aarent y�r
�• -^. whal is his / her e:acl share of interest?
name on record is d'rfFerenl Nan Urel of applicanl, indiple below:
Name at mortgagee or contract seller
AOtlress of moM1gagce a mnlraC seller (number antl st
Nartre of assignee w other owrrer or holtler of mw�gage
Address of assigiree (mmi6ei aM s6ee1. dty, sfate. .
Does eppliwM own poperty in any other
cwnty in Indiana?
❑Yes ❑ No
Deduclion aoomved in Ne amwnl of:
� �
SignaWreotCounryAuditor /�
`d
I/ We certify under the pen
tndiana a owner ot the �
gnaWre (o� e/ 1 - . )
esi enl address applicaM`
OS�O � E . �
appficanl the sde legal a equitade
If ownetl wilh somerne olher ihan spouse, indicate wifh whom.
�� '( _"„'�`="`
s(. oty, s6fe. and ZIP code)
�.cop� N��T
D �- �8/
20 � 20 � 20
❑ Yes ❑ No
Is t�e property in quesUon:
0 Real PropeM1y ❑ Mobile Home QC 61.
Has ttds deduc7ion been requested on property
tw artent yeal�
❑Yes ❑ No
20 _ � 20 _
oi perjury tl�at the above and toregoing infortnation is true and cortect and that the applirants was I were a resident of
nentioned property on March t, 20
�.
a by IC 67.
Adtlress M aultwi¢ed persm (number aM stree[. dry. state, aM
.L�i • h�7�/3