HomeMy WebLinkAboutMortgage_Foster (5).--,
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION
� I State Fwm 43709 (RS / d-03)
PrescnDetl by Departmem of Loral Govemmeni Finance
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RUCTIONS: � � File Marfc
oe filed in person or by mail with the CountyAudiror of the county where the property is located. y � �"�
Filing Oates: 1J Real Property: Dudng the 12 months before May 11 of the year the deduction is to 6e e8ectiJ�f nn,
2J Mo6ile Homes assessed under fC 6-1.1-7: Between January 1 S and March 2 of the year the ded Ction 5��HB�/fective.
See 2verse side Ior addilional instructions and qualifications. �j , �
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contract uyer - see restrictions on v
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Key number /
side)
description
. i
Page number
Dl3- o U �� �-cxJ .
Assessed vatue of real property as of Mortgage / ConVact indebtedness unpaid as of Is the applicant the� le legal or e
March 1, current year March 1, curcent year owneR [�Yes ❑ No
'�G8000,
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
name on
Name of mortgagee or contract seller
of mortgagee or contract seller (number and street, ciry, state, 21P
or other owner or holder of mortgage
Address of assignee (number and street, ci1y, state, ZIP code)
property in question:
al Property ❑ Mobile Home QC E1.1-7)
Dra���er NO.. 97 :.5...7.�/
Does appiicant own property in any other If yes, what counry? What 1 Card N� . .....................
county in Indiana?
// I /--� � �N �! COUNTY AUDITOR a�� n 7:� S 4 I_ '7
Deduc6on approved in the amount of:
20 O 20 20
� �
Signature
20
�
County Auditor
2� � I 2� � I 2�
�ested on
Yes ❑ No
I/ We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicants was / were
a resident of Indiana and owner of the aforeme�ned property on March 1, 20
full
Person authorized b�
or by IC G1.1-12-.07
Full �-' ��olica / Address of authonzed person
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Attomey