HomeMy WebLinkAboutMortgage_Nurrenbern (3)�
...��.
iy_ ;.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RB! 2-07)
Presaibed by Department ol Local Govemment Finance
�'��lr@��7���
�� �,,:i
File Mar1c
INSTRUCTIONS: .
To be filed in persron or by mai7 with fhe County Auditor o/ fhe county where fhe property is bcated. � �a�« �%�
Fding Dates: 7) Real Property: Dunng fhe 72 months belore June 17 0/ fhe year the deduc6on is fo be eflective. (�/ �l
2J Mobile Homes assessed under IC 64.1-7: Between January 15 and Ma2h 2 o/the yeai fhe deduct���8�i#ISeY AUDITOR
See reverse side /or additional instructions arrd qualifications.
Apq" t(owner or conhacY buyer - see reir�cffms oryreverse side) ,
Y' v� /
T' DisUict Key number / legal tlesaiplbn Record number Page numbar
���n-t-c�v 6 - /3 - 30 - /a o - � a!• �f �v - o o `� 8 s5� �
Assesud ralue of real popaty as of Mart�h 1, axrent y�r Mortgage / Contrad iMebtedness unpaid as M March 1, Is Ihe appGpnl Ihe sde legal w equitaHe wmeR
anml year �
/ SS DOv ❑ves ❑No
, whal is his / her exaG share af inlerest? If owned wilh someone dher Ihan spouu, indiwle wifh whom.
If name on recwd is diRerent �han iha� af applicant, intlirale below: Is lhe property in questian:
❑ Real Prt�peAy ❑ Mobile Hwne (IC 61.1-7)
Name of rrwrigagee or coniract seller
Address of mortgagee a conUad seller (number eM Sreel, , stafe, aM ZIP crotle) �
Name of asvgnee w oUrer owner or holCer of mw4gage '
Address of asvgnee (number aiM sGeel, city, sfate. arM ZIP mde)
Does appliwnl own praperty in any olher II yea, whet caunly? Whal Texing Oisiric�? Mas ihis dedudirv+ F^°^�--"-"—'—n propeM1y
counry in Indiana? - �� �
❑ Yes ❑ No '1 � D r v L� � ❑ No
DeducUon approved in the
��
Sig�Wre of CouMylwtliU
zo _
couNTrau
20
D ra��� cr N O. S�.o. -.,.+.. .<. ,..
./
C�I'(1 \� . .....................
oate (monur, ear r�A
I I We certify under the penalty of perjury tliat the above and toregoing intormaUOn is hve and correU and that Ihe applicant5 was I were a resident of
Indiana and owner of the aforemen0oned property on March i, 20 _
of applicanl
ezewted Power of Altnmey w by
Address of aWhor¢ed persm (num6er arM sveel
142-.07
Date (month. day. yee�
Y��