HomeMy WebLinkAboutMortgage_Aydt�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION o n T.vdi�n hi. Year
,«.
/ S�ate Fwm 43709 (R6 / 5-06)
� Resrribed hy DepaRment of Loml Gwemment Financa
1 n n
INSTRUCTIONS: �-y; File Mark
To be (led in person o� by mail with the County Auditor of the counfy whe�e the property is located. O'j� �I�g
Filing Dates: i) Real Property: Dunng the 12 months before June 11 of the year the deduction is to t���� b,�,e0��NTY (/ I
2J Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the year Ifie �deU"uchon i�� a��ffective.
See reverse side for additional instiuctions and qual�cations.
Appli t(owner or confract buyer - ee restnctions on reverse side)
Taxi District Key n ber / legal description Record number
07
/� a� i 9- -�- yoo 000. �� p-oo Page number �� 7
Assessed value oi real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunent year March 1, curzent year owner? ❑ Yes � No
� � � 000
If no, what is his / her exact share of interest? , If owned with someone ofher than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
Real Property ❑ Motxle Home QC 61.1-7)
N^^+e of mortgagee or contract seller --
Ad�dress of mortgagee or contract seller (number and street, cify, state, Z/P ; � 2E m Y P
Name of assignee or other owner or holder of mortgage �� � � �
�y��
Address of assignee (numbe� and s6eet, city, state, ZIP code) �/� ���
PI
Does applipnt own property in any other If yes, what county? What Ta ,,, nas this deducbon been requested on
wunty in Indiana? property for arrent yeaf? Q Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of: �
20�� 20�� 20� 20 20 20 20
{ � �
Signature County Auditor Date
I/ We certify under the penalty of perjury that the above and foregoing iniormation is We and corteci and that the applicants was / were
�dent oi Indiana and owner oi the aforementioned property on March 1, 20
a�ynat (owne ull n e) Person authorized by duly executed Power of Attomey
_ or by IC 6-t.t-12-.07
side ddress applicant Address oT authorized person
705� E. EcG�boro� C. 1-favbs��lf