HomeMy WebLinkAboutMortgage_Clarki i �°� STATEMENT OF MORTGAGE OR CONTRACT INUEBTEDNESS
�ji' = FOR DEDUCTION FROM ASSESSED VALUATION
�� SUte Fam 43709 (R6 / 5-06)
Presaibed by Oepartment of Laal Gwemmenl Finance
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INSTRUCTIONS:
Count T i Year
AUG 2 8 2007
File Mark
To be filed in person or by mail wrth the County Audito� o! the county where the property is located. `�j �
Filrng Dates: 1) Rea/ Property: Dunng the 12 months before ,lune il of the year the deduction is to be e/fectfGe' � �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the yeg{�Q�bYTI� td16NT§y�Lctive.
See reverse side /or additional instructions and qualifrcations.
Applicant (owner or contract buyer- see 2strictions on rev se side)
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Tauing District Key number / legal description . Record number
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���-�� a� /Y -/P- yo3 - oo� a 83�7 Page number y 5—� �o
Asseesed value of real prope s of Mortgage / Conlrad indebtedness unpaid as of Is ihe applicant the sole legal or equitable
Mardl 1, current year March 1, current year owne(? ❑ Yes � No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate wilh whom.
If name on record is different lhan that of appticant, indicate below: Is lhe property in question:
_ _ . ❑ Real property_ _ ❑ Mobile Home (IC 61.1-�
" me f mortgagee or contrad selter
Addressofmo a eeorcontractseller numberandstreet DCa��'el'�T�:Q,'�,lo?;^h:?(�
9 ( ry, state, ZIP
Name ot assignee or other owner or holder of mortgage Card i�i� . .. .... .. ... .�!
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Address of assignee (number and st2et, city, state, ZIP code) •
Does applicant own property in any other If yes, what county? What Taxing Distrid? Has lhis dedudion been requested on
county in Indiana? properly for cunent yeaR � Yes O No
COUNTY AUDITOR
Deduc[ion approved in the amount of:
20 �� 20 �q_ 20 20 20 20 20
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Signature County Auditor Date
' We certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
Signalure (owne�l name) Person authorized by duly executed Power of Attomey
' or by IC 6-1.1-12-.07
I resident address of applicant Address of authorized person
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