HomeMy WebLinkAboutMortgage_Pierce.��•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS nt 7 hi Year
FOR OEDUCTION FROM ASSESSED VALUATION
Stale Form 43709 (R8 ! 2-07)
���; •� Presvibed by Deparimenl of Loral Govemmenl Finance MA %� � Z009
File Mark
INSTRUCT/ONS: `-y� �!
To be filed in person or by mail wdh the CountyAuditor olthe county where fhe property is located. � �'fA� ��i^�
Fi/ing Dates: 1J Real PmpeAy: Dunng the 12 months belae June 11 0/ the year fhe deduc6on is to be etlecGve. C/
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 2 o/the year the ded�r�����c�iv�UDiTOR
See reverse side /w additional instructions and qualifications.
Applicanl (owner wmnVacY 6uye/r�- qe�estncfions on re'
�l,c.c�.rea„� o� �'Y,�zncc� �
0
Taprg DisVict Key n gal desaipl'an y - - Record number Page numbei
a.Le,�.,_o a�-./�l-l8-�-03_00,.59�-0o s183
0.ssesxed rdue M real as d March 1, wrenl year Mkv�gage / Contrad indebtedne55 unpaid as of March 1, Is �he appfipnt Ihe sde legal or equitada owne(
artent year L/ p
8 / p � ❑ Yes ❑ No
whal is his / her exact share of interest7 If wmed with someone alher Ihan spouse. iridirate wi�h whom.
i
If name on recwtl is drfierent than Ihat of applicam, indipte below: Is ihe poperty in question:
❑ R�1 Prtmertv ❑ Mobile Home OC 61
Name of mortgagee or coni`aa seller
Address of rtartgagce or
�����a
of asvgree (numbe� and sLeet, dty, sta(e. aM ZlP Code)
Does applicant own propeM1y in any Wher
counry in Indiana?
❑ Yes ❑ No
approved in the amount of:
�» '����
� -
If yes, whet counlyl Whal Taxing Dfsin
COUNTY AUDITOR
20 20 20
CWrrty
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N l� �.�.t-tQ,u��l %�/.�°
� U Yes LI No
20
20
I I We certify�nder the penalty �(�perjury thal ihe above and fwegoing information is true and correc[ and that ihe applicanis was I were a resident of
Indiana and owner of Ne aforemenCOnetl property on March 1, 20
I
� j�'3 3(� "� . C�. r
� Person aulhonzed 6y duly execuletl Pi
sfreet. cdy. sfafe.
w
person (num6eraMStreel.ary.state.arMLPooOe)
Date (monfh. dey, yea�
C-� -ir'1 � .�� �-( 7 �P �v (7
os�e �monm, eay, yeeq