HomeMy WebLinkAboutMortgage_Burtonidi�" s� STATEMENT OF MORTGAGE OR CONTRACT ItvDEBTEDNESS
�i�7'g�p(����; FOR DEDUCTION FROM ASSESSED VALUATION
":�I.v , State Fortn 43709 (R6 / 5-06) ' -
� Presaibed by Department of Local Gwemment Finarice
INSTRUCTIONS:
To be filed in person o� by mail with the CountyAuditor of the county where the p�operty is locaf.,...
Filing Dates: J) Real P�operty: During the 12 months befom June I1 0/ the� ar the deduction is to ��f(�Fti�.����1
2 Mobile Homes assessed under IC 6-1.1-7: Between Janua 15 and Ma�ch 2 o/the earYh`� e s to be elfective.
See reverse side for addrtional instroctions and qualifications. �� ��
or confract buyer - e resfricfions on revers �de)
%^J %� Y' ��� � 1���7C,(�V
� Key number / legal description
Asseesed value of real property as of
March 1, current year
d� -�9 -3/ -30/ - 000
MoAgage / Contract indebtedness i
March 1, curcent year
I ; _. :. �
%OS� nnn
If no, what is his / her exact share of interest?
If name ori record is diNerent than that of applicant, indicate below:
of mortgagee or contrect seller
Address of mortgagee or co,r tract seller
assignee or other owner or
Address of assignee (num6erand street,
G�BSON
Record number '
��Q 7
3 Page number
� ��74
as of Is the applicant the sole legal or equitable
ownef? ' ❑ Yes' �'No '
If owned with someone other lhan spouse, indiwte with whom.
Dra���erYO:PY��%;5r%'��'/ cs-ti-
�
���. Card NO :......................
and street, tate, ZIP D�a ���� ��O• Ud
Y-..� � � � _ ., . /
oi mortgage
state, ZIP code)
Does applicant own property in any other ( If yes, what county? What Taxing Distrid?
county in Indiana?
Dedudion approved in the amount of:
20 n
1
Signature
20 �J�
�
COUNTY AUDITOR
20 20 20
County Auditor
a
Has this deduction been requested on
property for cunent year? (� Yes � No
20
Date
20
We certify under the penalty of perjury lhat lhe above and foregoing information is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
na (ownels full m Person authorized by duly executed Power of Attomey
� I ���. .�y�-jyy� ) or by IC 6-1.1-12-.07
of authorized person