HomeMy WebLinkAboutMortgage_Blanton (2);��� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'i' � FOR DEDUCTION FROM ASSESSED VALUATION Count To s' Year
� w J State Fartn 43709 (R6 / 5-06)
Prescribed by Depariment of Laal Gwemment Finance
OCT 1 2 2007 •
INSTRUCTIONS: < Fiie Mark
To be frled in person o� by mail with the County Auditor o/ the county whe�e the property is /ocated. `�j ��
Filing Dates: 1) Real Properry: During the 12 months before June 17 of the year the deduction is to be efleL�tiS�`�
2) Mobile Homes assessed unde� IC 6-1 J-7: Belween January 15 and March 2 0( the p�g�� IsUel80�fiective.
See �everse side for additional instrocfions and quali�cations.
Applicant (owneiorcontract buyer- see restrictions on ievers 'de)
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Taxing Distrid . Key number / Iegai description Record number �� O l
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i`'i�'��'�00"� �� �OJ Pagenumber� A�� $
� V
Assessed value af real property as of Mortgage / ContraIX indebtedness unpaid as of Is the applipnt the sole legal or equitable
PAarrh 1, current year March 1, current year owneR ❑'Yes ❑ No
S�,�D�
If no, what is his / her exad share of interesl? If owned with someone other than spouse, indicate with whom.
If name on record is difierent than that of applicant, indicate below: Is the property in question:
❑ Real Properly _❑ Moble Home (IC G1.1-�
e of moAgagee or contrad selier �� v� r L� ,
Address of mortgagee or contract seller (number and street; city, state, ZIP . ,
Name of assignee or other owner or holder of mortgage �
Address of assignee (num6er and street, city, stafe, ZIP code)
Drawer N ,�„�„�q� ; ��ao8'
Does appfieant awn propeRy in any other N yes, what counry? What Ta '"••• :sted on
county in Indiana? (es� No
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`�'�O��c-cla �c(,� �"G, CGG,ao
COUNN AUDITOR
Deduction approved in the amount of:
20 � 20 � 20 � 20 20 20 20
P ` I�
Signature County Auditor Dafe
We certity under the penalty of perjury that the above and toregoing infortnation is true and correct and thal lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signatur� (owners lull nag�e Person authorized by duly executed Power of Attomey
� � or by IC 6-1.1-12-.07
/�^A .
G,���
�resident address of applipnt �76�( Address of authorized person
35 �7 E. /� � / . ,��-����.. s�/