HomeMy WebLinkAboutMortgage_Logestan"' �'"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
:: FOR DEDUCTION FROM ASSESSED VALUATION �
�, / State Fwm 43709 (R4 / 70.07J . . ' ' •� . . .. .. . .. . . .. .
� . PrescribeA by Departmenl ot Lonl Gavemment Finance
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INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor ol the county whe�e the propeRy is located. MQR 1 � 2��4 �
Filing Dates: 1) Real Property: Dunng the 12 months 6elore May 11 0/ the yea} ttie deduction is to`6e eHective. '� ��
2) Mo6ile Homes assessed underlC 6-1.1-7: Between January� i5'and March 3'1 /of the y`ea���t/he deduction is tabe effective
See reverse side !or additional instructions and qualifica6ons. � '7�-wi7`l�,�c,;,c,��,� •
a l�- , 3-34 -iao �. ���-- cn,� �.o;�. .. ., , :...,._�
�,Applicant (owner or contract buyer- see resMctions on reverse side) � � � ' � - � �
I Lu rr� E' �o `�' u v(G� Lo �"q
Taxing Distnd Key number / legal description Record number
, � .03= .
C�Ivv�b'r� Tou��tiiP
Assessed value of real property as of
March 1, curtenl year
no, what is his / her exact share of interest?
If name on record is different lhan that
of mortgagee or contrect seller
�Q 3� m D r)� �� D Page number' '
CJ J J � �f �
Mortgage / Contrad indebtedness unpaid as of Is the applicant the legal or e
March 1, current year •_ ownef?t ., es.:❑;No
� 6 3� od 0 ..
If owned with someone other than spouse, indicate with whom.
below:
Address of mortgag�e or contrad seller (number and street, city, state, ZIP
zl .S� 3rd . t�av,s v; lle L/1
Name of assignee or other ow er or holder of mortgage �
7 70 .�
Atltlress oi asslgnee (number and st�et, city, state, ZIP code) .. � ,
Does applicant own property in any other If yes, what county? What Taxing Distrid? �
county in Indiana?
COUNTY AUDITOR
ueauction approvea in the amount ot:
20 � 20 n��
Signature
�perly .;�OMobileHome�QC61.i
. . .:. ... . -. .. �, � . �.
Has lhis dedudion been requestetl or
property for current yeaR 0 Yes ❑ N
20 �% 20 _� 20 �`L 20 20
� P P
County Auditor Date
I/ We certify under the penalty of perjury lhat the above and foregoing infortnation is true and cortecl and that the applicants was / were
a resident of Indiana and owner of lhe aforementioned property on March 1, 20
Full �esidenf address of
� RRI[ihri8'fCC_
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Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 j
person
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