HomeMy WebLinkAboutMortgage_White (2).•"^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C own i ar
_. _'� FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (RB I 2-07)
�� u,. � Presrnbed by Departmenl of Loral Govemment Fi�nce
e1�Aark v
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor o/ fFre county where fhe pioperty is located. �-yh ��
Fding Dates: i) Real Property: DuAng the 72 months be/de June 11 0! the year the deduction is to be elfective. O'�
2) Mobile Homes assessed under IC 6-7.7-7: BeM1veen January 15 and Maich 2 o/the year U�e deduction iCt'BbSeO����TY AUDISOR
See 2verse side (a addifional insWcbons a� qualifications.
(owner a mnhad Wryer -
aricl Key rn�mbr� / legal desoiption Rewrtl number Page rwmbal
� �� - i3 -a.� -�oo -aoo, �oi - oo aao � 93
value of mal piopgty as d Ma�ch 1. aarent year Mongage I Coniraa indebiedness unptid as M Mard� 1. Is the appGpnt Uie sde legal a equitade wvne/?
ainmt year
� OO� ❑Yes ❑No
t is his / her ezad slare of inlerast? If mvned wNh someone olher ihan spouu, indicate wilh whom.
If rame m record is d'rf(erenl ihan thal
Name of rtartgagee or conUaU
mortgagee or oonuaa seller (num6u6M Aree4 dty.
��
sigrree or alher owner rn hdder d mortgaga
Address of assigree (num6er arM sfreef.
arid
Is ihe property in questim:
❑ R�I Pfoperty ❑ Mobile Home pC Gt.t
. . . . _ CJN-r�L-.�s.—
J�c•� S� u A p �S
Does applicaM oxn property in any other If yes, whal counry? �� I a:�' �Q �^ �Y
counry in Indiara?
❑Yes � No 7'A �O . : � No
,¢I y Q �EA+� 4J �2TA Kt�Z
�o��nA. /is, 2 a�. oa ma�T�,��,�
Deduction ap0�'� � �e amounl of:
0
SignaW re of Caunry Auditor
p_ I 20 I 20 _ I 20
Camry
20 � 20
day,yea�
I/ We certify under Ihe penally of� pe�jury that ihe abrne and foregoing infortna6on is trve and mrrecl and that the appGpnLS was I were a resident of
Indiana and owner of Ihe aforementioned property on March 1, 20 _
Pason
(number
by IC 61.
of aulloraed person (numbei antl stree(. aty. s(ate. aM Z!Y coee)
day, yza�