HomeMy WebLinkAboutMortgage_Martin (2)'�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709 (R8 / 2-07)
�6 � Resrnbed by Depanment o( Local GovemmeM Finance
INSTRUCPONS:
To 6e fifed in person w by mad wrth the CourrtyAuditor o/ fhe courtty wheie the proper(y is bcated.
Fd'o�g Dates: i) Real Property: Dunng Ne 12 mortths be/ore June 11 d tlre year the deduction is to be e/%ctrve. p p p t�ib�e�-
2) Mo6iie Homes essessed �mder IC 61.1-7: BeAreen January 15 end March 2 of tl�e year fhe deducti0n 4S
See reverse side fa additional insWCfions and quaGficalions.
oisllid
Key
Assessed rahie of real prapeAy as d March 1. a+rart ymr
ihat o( appiice�l indmte belwr.
Name of morigagee or conUaU sdler
ndaress m mongagea or mnvaa
a otAer owner w hdder of matpage
�
p:�-OOD.�S'3�o0/
WeDted� unpaid�s.pF Mar'h 1. Is Ihe a
1 S LJ LJ
It owmetl wiih sort�eme aher Ilwi spouse.
state, erN LP ootle)
Atldress of assi9rree (ixm'ber aM st/ed. dty. stste. ard ZIP code)
Daes ePplicaM ovm praperly in anY o �— u��_r�.w� �atrici?
�,my � i�a��a ��C.S �'A/F(J(� 0 /Y1�f,�i-
❑Yes ❑ 2�
�=r
omuction appio-.ed in u�e ama,m o�
� a � o� - a�o � zo_
�f —
C
❑Yes ❑No
Is �he property in questim:
❑ Real PropeAy ❑ Moble Home QC 61.
2�
requested on property
❑Yes ❑ No
20_
I/ We certify under ihe �alty of perjury ihat Me above and foregoing infortnation is We and corted and ihat the appGranis was / were a resident o(
Indiana and owner of ihe aforemenfimed property on March 1, 20
,� a ress ot icaN (num6el and sGest, aly. slafb. enALP e�
�! � 7 v� l' �� S i� Cy �4 �r A i-r c. ;�
Person aWhataed by duly exewted Power of Attamey a by IC 61.1-12-.07
pe�son (number aM stree4 U�: state. aM
Dale (monM, day, yean
�f7 G'Cv
day. yea�