HomeMy WebLinkAboutMortgage_Ball�; i 4 STATEMENT OF MORTGAGE OR CONTRACT INDEE3TEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION ._ Coun Year
J Stete Fwm 43709 (R6 / S-06)
� Presvibed by Depanment of Loral Gwemment Finance
DEC 1 9 2007
INSTRUCTIONS: File Mark
To be /iled in pe�son or by mail with the CountyAuditor o/ lhe county where the property is.located: � �
Filing Dates: 1J Real PropeRy: Dunng the 12 months 6e(oie dune I1 0/ the year lhe deducGon is to be eBecGve.� �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 0/ the y�O�ALOklAbTi�is���e�ctive.
See reverse side for additional instnictions and quali(ications.
ir contra buyer - see res ctions on reverse side)
a� T. `� �_
Taxing Disirid ' Key number / legal description Record number � O� n
� a(o-/3-/a-a-oo- oo�. '
� Y�' DO / Page number 7 Q��
50 /
Assessed value of real property as of MoAgage / Conlrad indebtedness unpaid as of Is the applicant the sole legal or e
March 1, wrtent year March 1, cunent year owneR ❑ Yes ❑ No
70 8��
If no, what is his / her exact share of interesl? If owned wilh someone other lhan spouse, indicate with whom.
If name on record is different ihan ihat of applicant, indicate below: Is the property in question:
of mortgagee or contrad seiler
Address of moRgagee or conVad seller (number and st2et, ciry, state,
Name o( assignee or other owner or holder of mortgage ,
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
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Deduction approved in the amounf of:
�
Signature
��1'�
G
2C _
County Auditor
❑ Real Properfy ❑ Mobile Home
�
�DO� -7�6�3
�/��e /i'jO��Clu`1�-
� 70, ��� Do
Date
�0
61.
d on
� No
certify under the penalty of perjury thal lhe above and foregoing information is true and corred and that the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
name)
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
rappucan� Address ofauthorized person
on nnd�..�0 �.�,. ,n �n«n