HomeMy WebLinkAboutMortgage_Memmer (3)�
�i �A� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
's'�,i. FOR DEDUCTION FROM ASSESSED VALUATION n ' hip Year
' � ..� • State Fmm 43709 (R6 / 5-06) - �
� Presoibed by DepaNnenl of Lopl Govemmenl Finance
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INSTRUCTIONS: T �OC L r/ �O}p F• ,�
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To be filed in pe�son or by mail with the Coum D ra�ver 1 �••• •""" d '�'i16� F��+��
Filing Dates: 1) Real PropeRy: Dunng the 12 i ' '0 6 g�act�vgy�NTY AUBITO�
2J Mobiie Homes assessed undei , �_ �. , ,- . . . .... . . .. .. . ���ar the deduction is to be eBective.
See reverse side fo� additional insfructions and
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Applicant (o contracf buyer - se s'ctfons on reve e side
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Taxing Distrid Key number / legal escription Record number
l.��f"lt/Yx. (f�ct� Q� . �� 3C�/ �i�— CT�� �L 6
Page number �� � �
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, current year owneR ❑ Yes ❑ No
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
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If name on record is different than that of applicant, indicate below: Is th roperty in uestion:
❑ Real Property p Mobile Hane (IC G1.1-�
me of mortgagee or contred seller �� �C.!/d-/�-�
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what wunty? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for wrrent year? � Yes ❑ No
COUNTY AUDITOR
Deducfion approved in the amounl of:
20 O 20 �� 20 09_ 20 20 20 20
P P P
Signature County Aud'Aor Dale
�/ We certify under the penalty of perjury that the above and foregoing infortnalion is true and correcl and that the applicants was / were
a resident of Indiana and owner of lhe aforemenlioned property on March 1, 20
ature (owners Iull name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
II resident address o applicant Address of authorized person
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