HomeMy WebLinkAboutMortgage_Brown (3).�°� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
_. _� FOR DEDUCTION FROM ASSESSED VALUATION
� S�ate Fwm 43709 (Re / 2-07)
�� ww 1 Presrnbed by Departmenl of Local Govemmmt Finance
INSTRUCTIONS:
To be filed in person or by mail wifh the CountyAuditor o! the county where the properfy is located.
Fding Dates: 1) Real Pmperfy: Dunng the 72 months befwre June 11 o/the year the deduction is to 6e el(ec6ve.
2J Mobile Homes assessed under IC 6-7.1-7: Behveen January 15 and March 2 o7the year the deductirn i$ (qbe �eEtiv�Qa
See reverse side fa addGona�bons arni qualifications. MHT
P,pplicarrt (owrier
Acsessed rdue of rral popgty as
is his ! her exad share W interesl?
If name on record is d'rftere�l than thal of
Name of martgagee or conUact
I I desaiption � li� 3tL�itdYiVr7llier. ... Page rnirtiber
— / — /—�.30�3— 00�..35a-t7 3��
year MMga //ind�ebtedness unpaid as of March 1, Is ihe appGcant Ihe sde legal w equitade owneR
�rt�` .`'� �/ /nr`�! ) �YeS ❑ No
someone ather Ihan spouse, indicale wiUi wtqm.
Address of mortgagee or conlrad seller (numbu arrd 9�eel dty. 9ate, aiM
assignee w Wlrer owner a hdder of mart�a9e
Address of assignee (mrtnbei and sfreet,
Does applicant own poperty in ary oNer
caunry in Indana?
❑Yes ❑No
Deduction app�oved in Ihe amount of:
r� � � � I
oode)
If yes, what muMr
-- �-�, JlwcdL �°^�
�('�...:^........ 20
DI'a\\'CI' 1��..'•^
Is Ihe property in question:
❑ Real Prqperty ❑ Mobile Home (IC 67.1-7)
Has lhis dedudion been requested on property
for artent yeaR
❑Yes ❑ No
20 I 20
�reWr f n AudMr �� �� t � �a�e ��V � ^�
.'.�y............
Card \O. ........ ' 02-��
1! We certify der penaity of i �� "-- '' .._ _..,; end correct and that the applicanLS was / vrere a resident of
Indiana and owner of ihe aforeme..:_...... �...�.�, �y wi march 7, 2b
�reLUe (a+Y��'slWlname) � _ Date (monN. OaY. Y��)
�rdent adtlress of applicanl (nwnber aM stree7, city. sta(e. and ZIP mtle)
� 2.t (o S _U te,lE �� Ff!{.G /�3�
Person auUorized by tluy enecuted Power of Alla�y n by IC 61.1-12-.07
auUrorizedperson (numbeiaMsliee4aty.
(ar• �L7� 3
Oate (month, day, yea�