HomeMy WebLinkAboutMortgage_Powers.�� STATEMENT OF MORTGAGE OR CONTRACT INDI
r�,... _ FOR DEDUCTION FROM ASSESSED VALUATION
- � State Fortn 43709 (R8/2-07)
- � Presmbe0 by Departmenl of Local Govemmenl Finance
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor o7 the county where fhe property is located.
Fding Dafes: 7) Real Property: Dunng the tt months before June 77 0l the }rear the deduction is to be effective. p �
2) Mobiie Hames assessed under IC 6-L 1-7: Befween January 15 and March 2 of the year Ure deduc6on iq� �e ec6�(f �
See reverse side lor addiLonal instructions aid qualilcafions.
see 2sfnctions on
Key number / �egal desrnption
— 'J— � Y'�JJ — CJ6�/ • �/7'Ol " �
value ot r� popaty as d March i, artenl year Mortgage / Conbad inOeWedness unpai0 as of Mamh 1, Is the apptimnt Ihe sde legal a equitade owneR
anrerrt year
)310OD ❑�e5 ❑No
t is his / ha exaci share of iirierest? � Itowned wilh someone olher than spouse. indicate with wham.
reme m
Ihat of applican� indipte belaw:
Name of morigagee or crniract seller
Adtlress of morlgagce a mnUaq selier
oaner rn hdtlet a
sbeet. dr
Does aQpicant own property in any dher
county in Indiana?
❑ Yes ❑ No
apptwed in the amounl of:
���� ���Y�
��t.
U 1':111'CI' 1� 0. �,/.—.�. (O � O
C.11'(� 1�'�. .........
20 _ I 20
Counry
20
Is Ihe property in quesUOn:
❑ Real Pmperty ❑ Mobile Home
Has lhis dedudim� been requesled on praperly
fw anenl yeaR
❑Yes ❑No
20
20 _
I/ We certify under the penalry of perjury that Ihe above and foregoing infortnation is Vue and mnect and that the applic�ants was I were a resident of
Inaiana and owner oi the afwementloned property on March 1, 20
address of applicanl (number and st�eeL ci(y. sfafe. arM ZIP code)
Person auUwr¢ed by duly execvled Power of Allomey or
and sher,t aty. slate. antl ZIP code)
Date (monfh, day, yea�
Da�e (rtpnth. day. yea�