HomeMy WebLinkAboutMortgage_James�=�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
,;... _= FOR DEDUCTION FROM ASSESSED VALUATION
S1ate Form 43709 (RB / 2-07) �
°�;,,� 1' Presrnbetl by Department of Local Govemment Finance
i e Mark
INS7RUCTIONS:
To be �led in person or by marl viifh the Courrty Auditor o7 the counfy whe2 the pmpeRy is located. � U G � Q � Q Q$
F�Iing Dates: 1 J Real Property: Dunng the 12 months befwe June 71 0( fhe year fhe deduc6on is to be e/fec "ve.
2) Mobiie Homes assessed under IC 6-L b7: Behveen January 15 and March 2 0( the year Ure deduttion is to be eflective.
See 2verse side_/w addilional ins6uctions arrcl qualifications. �� �!!�
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��dng OisUicl" Key number I legal d�xiplion
- -� �- o F,�o
Assessed value of rral popaly as d MaRh 1, artenl year Mwtgage I(
curtenlyear
what is his I her eucl share of interesl?
.
If reme m recwd is diRe+eM ihan Nal of applicant indipte below:
Name of nwr�qagee or contracl seller
AAdress of mortgagee or cmVad sdter (number arr0 s6
Name of assgriee « otfrer owner a hdder of mwtgage
epplicanl wm property in arry olha
y in Indiana?
❑ Yes � No
amount of:
�
sfafe. and ZIP cotlel
Reoord iw er Page number
o as �:
as ot Mamh 7. Is Ihe app6cant Ihe sole legal a equitade owne(
❑Yes ❑No
If owried with wrtieone dher than spouse,
�
��JOB- �-s:73
.
Drawer N ........... .
('al'��. ... ....
L a-i.iii �- qU c� 916�°`
20 _ I 20 _ 20 _
is Ihe property in question:
❑ Real Property ❑ Mobile Hwne QC 61.1
Has tltis deductan bee� requested on property
r« a,rrent yean
❑ Yes ❑ No
20 � 20
day, yea�
I! We certify under the penalty of perjury tliat the above and fwegoing infortnation is We and correcl and that Ihe appliranls was ! were a residenl o(
Indi na and owner of Uie aforementioned property on March 1, 20
e{ ers nai�artre) Date (monfh. aay, Yea�
1�� A . ' w.. •� .
d plic�ll (nu 6er antl sLeet. cily. sfate. aM ZIP cvde)
�. � �
iu'y ex�ower M Atlomey or by IC 67.t-12-.07
n426�D
persm (numberaMsfreeLafy,sfafe,andZlPoode)
Date (monfh, day, yea�