HomeMy WebLinkAboutMortgage_Bogan.e�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
��, .. � FOR DEDUCTION FROM ASSESSED VALUATION �
- Slate Fwm 43709 (R8 / 2-07) -�(
�'';.,. � Presaibed by Departmenl ol Local Govemment Finance
INSTRUCTIONS: 1
�] F2�U��`
To be filed in person or by mail with the CountyAuditor ol the court[y where tFie property is located. � D�C J 1
Fding Dates: iJ Real PropeAy: Ounng the 12 monfhs be/are June 7f o7 the year the deducfion is to be eHective.
2) Mobile Hames assessed under IC 6-7.7-7: Behveen January 75 end MarcA 2 of the year the deducfion is fo be eflectti¢.
See reverse s�Iw addi6onal instructions a� qualificafions. ��ry/6 ���'�
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Appicam (o� n/a contrac{buyer - see ons on reverse si0e)
LJ � Q�/
T DisVi Key num6 r legal desvipibn
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Assessed value ot real property as of March 1. amnt y�r Abrtgage I Coritract
curtent year
1
If r; whal is his I her ewct share of interesl?
If name m recortl is d'rf(erenl than Ihat of applirant, indiole below:
��9a9ee or coniracl
rtartgagce w mntrae
Name of assignee a ather oaner or holder of mortgage
Address oi assignee (number arH sfreel. city. Aata,
Does applicanl own property in arry dher
counry in Indiana?
❑Yes ❑ No
Deduction approved in Ne amoun� of:
�P�=�j��
SyreWreofCounryAudibr IUI'
ti�.
as oi March 1
G�BS�N
RecoiQ{i�er Pag� nu�
U C
Is ihe appGranl ihe sde legal w equitaWe
with sommne oUrer than spouu,
yea. whet counry? 1 wne. n.�__ .. -..._'"' _
/2" 3il
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a�i- ioq
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Isthe property
❑ Real Pmp
❑ Yes ❑ No
� Mobile Home (IC &1.1-7)
Has U�a dedud'an been reques�etl on popaM1y
for wrtent yea(1
❑Yes ❑ No
20 20 _
Date (manN. daY• Yee�
I/ We certify under the penalry of perjury that the abwe and foregoing informa6on is We and cortect and Uiat the applicants was Lwere a resident of
indiana and owner oi the aforementioned property on March 7, 20 _
��wre (ow ers full name
FuA resitlent address af appl M(number and sLeef. cdy. sfafe. aM ZIP cade)
�l� O L„ , , /c�e �
Person authonzetl by duty execvled Power of Attomey a by IC 61.1-12-.07
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AdEress of au1Mr¢ed person (number and shee4 uty. slate, end ZIP oo0e)
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oate (monfh. aar. r��
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