HomeMy WebLinkAboutMortgage_Crance.� °•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
Stale fartn 43709 (RB / 2-07)
S r�u � Presrnbed by Department of Local Govemmenl Finance
INSTRUCTIONS:
To 6e filed in person or by mad with the CountyAuditor of the cou�rty where fhe propeAy is located.
Fd'org Dafes: iJ Real Property: During the 12 mon&s be(ore June 11 of the year the deduction is fo be elfec6ve.
2) Mobile Homes assessed under IC G1.1-7: Befween January 75 and March 2 o7the year fhe deduction is.to 6e e9ectivq�08
See reverse side la additronal insWCtions aiW qualificafions. H I' tt 1 L
Key n
dMardi 1.
of applzxnt, indicate below:
Name of rtqrt9agee or canitact sdler
Address of mortgagee or conlydd sellx
-1 �o
sfieef. tity. stete. arM ZIP
Narne af asvgnee w other oaner a hdder of morlgage
�On.114--a D� 3s
unpaid as of March 1, Is Ihe app8canl Ihe sale legal a e�piitade ovmeR
� ❑Yes ❑No
med wi�h someone dher ihan spouse, indcate rriih whom.
Is Na property in quesUOn:
❑ Real Provertv ❑ Mobile Home OC 61.1
ss of assignee (number arM sUee; dty, slate, and ZIP code� �-- "—
��n� p�.� � ' faxing Disind?
y in Inda�al
� n�-�„��,� �o..Q.�-...3.:s.
0
Cill'(1 �� . ..................... OR
in t
( _ - , ( tu _ 20 20
4udilor � Counry
4udion been reques�ed on properry
�n
❑ Yes ❑ No
CZ'�.
20 _
I/ We certify under the penalry of perjury ihat the above and foregoing infwmation is We and mrrect and that the applicants was / were a resident o(
Indiana and o er of ihe aforementioned property on March 1, 20
��f��.a � fidleemel �-- Date (mmth. day yeaQ
tlent addres�aYapplirant (num6er and s�r (city. state, aM ZIP oo0e)
;�-J Z LV 5 i- si-Q.� 2U�-+� t� �
aulharized by duy exeated Power oF Allnmey w by IC G7.1-12-.07
Address of aulhor¢ed persai (numbei aM sheeG dty, sta(e. aM ZIP co0e)
Date (rtanth. day, yea�