HomeMy WebLinkAboutMortgage_Sullivan.� °•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (R8 / 2-07)
�� ,�„ 1 Presrnbed by Depanmenl of Local Govemment Finance
INS7RUCTlONS:
To be filed 'm person or by mad with the CounfyAUditor o7 the county where the pmperty is located.
Fd'mg Dates: 1) Real Proper(y: Dunng Ne 72 months belore June 11 of the year the deduc6on is to be eRective.
2) Mobile Homes assessed undei IC 6-7.7-7: Behveen January 15 and March 2 0/ fhe yea� the deduclion i� t�e �lf�ti�e�0 �
See reverse side /d addifional inshuctrons arrd quali�icafions.
Andicant(mmer�mNrarl6wer-see mreverse "e) _ n ' �
�ri�u�i�sr:rv��
_ �
is his / her enati share of iirtemsl7
If izine m record is d'rfFerent Ihan �hal
of rtqM1gayee orwM1fdcl sPJler /.
—/
's of moAgagee ar conirad seller (numbes aM sG
of assgnee or Wher aw�rer w hdder of matgage
Address of assgnee (number arM sLee1.
Dces applicanl am property in arry oU�er
counry in Indana?
❑Yes ❑No
Deduction approved in the amwnt of:
20 �$ 20 �
SignaW re of Cwmry Auditor
sfafe. ane
LIY oDtle)
If yes, what counry?
RemN numba
—uv i v
�e.ss unpaid as of March 1, Is �he appfipnt Ihe sde legal or equtade ovmeR
� Yes ❑ No
If wmed with sameone other ihan spouse, �cate wiN whom.
I:
Dra��•er NO...Q. �..-..a. �O.°,�
— — CaCd NO. �
.....................
COUNTY AUDITOR
20 _ � 20
Has this deduction been requested on poperty
fw airrent yeaR
❑Yes ❑ No
20
��.5��
I I We certify under the penalty of perjury that the a6ove arW (oregoing infortrwtion is trve and cortect and ihat tlie applipnLS was / were a resident of
Indiana and ovmer of ihe aforementioned property on March 1, 20
wre (o:mers lidi nar�) oate (mmu, dar. r�A
� I � denl drese of applicaM (ni
� ��� 5
Permn auUai¢ed by duy ezeculed
Adtlress of aullror¢ed persai (num
city, sfa(e. aM ZIP co0e)
'Q�K(��SCO S�
� ar W IC 61.142-.07
arM sheeG aty, stafe. arM ZIP oode)
Date (rtronfh, day, yeaA