HomeMy WebLinkAboutMortgage_Dennis.� "'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
Y�'.�� FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R8 / 2-07)
°��. '� Presaibed by Depariment ot Local Govemment Finance
'le
INSTRUCTIONS:
To be filed in person or by mail wifh the CountyAuditor o! fhe county whe/e the property is located.
Fi/ing Dates: 1J Real PropeRy: Dunng the 72 months be%re June 17 of the year the deduc6on is to be elfecGve. �� j 2�
2) Mobile Homes assessed under IC 6-7. 7-7: Between January 75 and March 2 0/ the yea� the deddL��7onRis ro be ef/ 09 e
See reverse side la addi6onal insGuctions and qualifications.
buyer
Assessed ralue of real popaty as
yyhu on l V si08) O
mber I le . I esaiption
��
arrenly�r Mortgage/Contrai
uo, what is his / her ezact share of interesl?
name m record is difterent Ihan ihal of applicanl, indiqle 6elaw:
mortgagee or conLact
Address of mortgagee or mntrad uller
stete. erM ZlPCOde)
Name of assignee or alher o.vner or holder of mortgage
Atldress ot ass9nee (number arM sVeeL city, sfate. aiM ZIP code)
Does applicant own property in any olher If yes, whF
counry in Indiana?
❑Yes ❑ No
ii—✓I
•, �� •,
« equ�uae ownar
i �.,__ n.,_
If wmed wiU� someone dt�er Nan spoux, �tale with whom.
o �- c� aa.�
Ro3� 3 oo-'u� s�
„e���,,_>>
uestetl on poperty
❑Yes ❑No
COUNTYAUDROR
Deduction approved in the amount of:
20 � 2b _ 20 20 20 20 _ 20 _
'J
Signawre ot Counry Autlaor Counry Dale (mmlh, dey, yee�
I/ We certify under the penalry of perjury that the above and toregoing intortnation is W e and correct and fhat tlie applicants was I were a resident of
ndiana and owner of the aforementioned property on March 1, 20
I aWre wne(slull me) � . Datel��.daY.Y��)
�� �" � v.
�Fu0 ra 'denl adtlress ot pplicant (number and.s/treet. cdy. sfafe, aM LP wtle) C
�P l� ' n � �
Person aulhonzetl by duty executed Power of Albmey or by 6.1-12-.07 � �ate (mmN. dsy, yee�
Atltlress of aulhorrzed person (numberand s7ee1, aty. state. aM ZIP mde)