HomeMy WebLinkAboutMortgage_Falls (5).r °'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �� �
State F«m 43709 (R8 / 2-07)
�� � Prrrnbed by DepaNnenl W Local Govemmen� Firence
iNSrnucnoNS:
AUG 0_5 2pQ� �nanc
To be filed in persar or by mad wGh the County Audifor o/ the county where the pmperty is bcated. .
Fding Dates: 7J Reai Property: Dumg the 72 months before June 77 0( the year the deduction is to be eBeclive.
2) Mobile Homes assessed under IC G1J-7: BeM1reen January 15 and Ma/ch 2 olthe year the dedu�" o��tive.
See ieverse side fw additional insWc6ons a�M qualilcations.
T rg Ois4ici ' Key riumber / lega
% a b 13-.3s-
s ���¢ af real poperty as af Mardi 1. arrenl year
ezacl
of applicanl. iMimte below:
Name of mortgagee or cmlrxt seller �• •
Address of mortgagee or mntraG sdler
Name of assi9riee ar alher owner a hd
Address of asagnee (numba arW sLeet, aty. 4ate, aM LP mde)
�perty in arry o�hu If yes, what
❑Yes ❑ No
L7u�
arM ZIP oode)
unpaid az of MarCh 1,
If oaned wilh someone
Whal Ta�cing DisUicl9
Is �he app6fant IhB Sde legal « equlUda oMier7
❑Yes ❑ No
spouu, "vdicate with whom.
Is Ihe propeM1y in 9uestion:
❑ Real Pfoperty ❑ Mobile Home (IC Gi
# 09-N3:�
Has �his deductia� been requestetl on properly
for artenl yeal�
❑ Yes ❑ No
Deduction approved in ihe amounl ot
20 O 2b 20 _ 20 20 _ 20 _ 20 _
SignaWre of Caunry Fwtlilor Counry Dale (mmN, day, yea�
I/ We certiy under the penalty of perjury that ihe above and foregoing infortnation is true and corted and ihat the applicants was I were a residen[ o(
Indiana and owner of ihe aforementioned property on March 1, 20
sy�w�a �owners ee���� Dafe (monlh. AaY.Y�A
�
�ytlenl address ot appli�ant (num6er and sbeef, dty. stafe. and ZIP co0e)
Pason author¢ad by duy eaecuted Power oF Attomey or by IC &7.7-12-.07
Add,ess of a��hor¢ed prlsan (nwnber arM sGce7, aty. slate. and LP c�e)
Date (rt+mlh, day, yea�
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