HomeMy WebLinkAboutMortgage_Askren (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownshi ear
__ , FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R71 / 6W )
� y�. � Presnibed by DepaNnertl o( Loral GovemmeM Firarce
File Mark
wsrRUCnoNS:
To 6e fi(ed in person or by mad with the Counry AWitor o� Counry Reoolder o! fhe wunty wl�ere the poperty is located. �
F(Ihxj Dates: 1) Real Pmperty: Must file durirg Ne }rear lor whifh Ne deduction is sought � � County Auditor
2) Mobde / Manu/actured Homes not assessed as Real PropeRy: Must file dunng tAe fwelve (12) months /I,(��. ,
belore March 3f o(each year the deduction is sought �'��Yff��
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See reverse side Ior edtltional instnxtbns arM qualificatbns. GIBSON C
c��'i �T��i•�
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Ii ro, what Is ha I hew e�s shara or interest7
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brtpape/ Contraa In0e00eO�a unpaid as of MMgage I ContraG uWebcedness �mG� as d Is Me aOG�� tha mle
� 1. anent Y� aate M aOaimY�m kgal w eWimde aw^e(1
O � ❑ Yes ❑ No
rc ow�rea wiN someo� ottcer than spouse. 4d'icate vrim wMm
Pdd� of �mh�a9ee or wntraU seAer (numDei and stree4 <'M
Name of assignee or oNu owner or noma of rtrtxtgage
nae�.s
muHy in InOiana?
M sveeL my. stafe,
any oNer
Yes ❑ No
f
Yw, what count�/1
ia lM Pra7enl' in Ouestion: Mnue%ASUSSeE
❑ Real RoPetY ❑ Mn�dNPsse�ed
Mobile Fiortie (IC 6
Dr��vcr , .
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C81-C� 1�'�. ....I.�d�
What Taang �atrict? I Has iha deduction Deen re9uesteE m propaty
ror curte^� year' n., n
COUNTYAUDROR
D��cGan aGW� in Cre amouM of.
20 20 20 _ 20 _ ZO _ 20 _
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QI
Sigia4rte d CoumY /wdttw Counry Date (montA. dav, Yee�
I I We certify unAer Ne penalry of perjury that the above and foregoing infortnaUon is trve and correa arM that the applirant is a resident of I�iana aM
owne f mntraU buyer ot ihe aforemen[ioned property on date application is filed.
(axne ^ narre) Date (rtmfh. daY. Y�h
�
Fu0 ' ent address ot appGfant (num6erand street mY. ��. � LP tak)
Person autharaed Ey MYy es¢cuted Power W AttmieY � bY IC 61.7-12-0.7 � Date (mmM. Oa}; yae�
Address W aW�or'¢ed De�^ (numbe� antl street c�N. state, end ZIP rotle) .
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