HomeMy WebLinkAboutMortgage_Chitwood/e; 'ry�.� STATEMENT OF MORTGAGE OR CONTRACT INDEi3TEDNESS
'i :�'r FOR DEDUCTION FROM ASSESSED VALUATION _ T s ip Year
M� J SUte Fwm 43709 (R6 / 5-06)
� Presoibed by Depariment of Local Gwemment Finance
INSTRUCTIONS: �File Mar�.
To be filed in person o� by mail with the County Auditor of the county where the property is located. �'�S �a`%�.
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Filing Dates: 1) Real Property: Dunng the 12 mon[hs 6efore ,lune If o( lhe year lhe deduction is to be efj��iy�, COUNTY AUD�TOR
2J Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the yeaP e`�educUon is to be eflective.
See �everse side for additional instructions and qualifica[ions.
Applicant (owner or contract buy - s restrictions o�everse side)
Tauing Distrid Key number / legal description Record number
- a�-�y-,�-,oy_aoi,�ss-u,7 Pagenumber �� I b
Assessed value of real property as of MoRgage / Contrect indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, curzent year March 1, current year owneR �1 es ❑ No " `
� 07 � �
If no, what is his / her exact share of interest? Ii owned with someone olher than spouse, indicate with whom.
If name on record is different than
of mortgagee or conlract seller
applicant, indicate below:
– — - �.yi - , �
Address of mortgagee or conVact Iler (number and street, city, state,
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what counry?
county in Indiana?
DeducGon approved in lhe amount oi:
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COUNTY AUDITOR
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County Auditor
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We certify under lhe penalty of perjury that the above and foregoing infortnation is lrue and corred and lhat the appticants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Full resitlent atltlress ot applipnt Address of authorized person
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