HomeMy WebLinkAboutMortgage_Greubel (4)��� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
��! j SUte Fortn 43709 (R6 / 5-OG)
Prwaibed by Depenmenl of Local Gwemment Finarxe
INSTRUCTIONS: �}1 � Fi a{r �
To 6e filed in person or by mail wdh the CountyAudito� of fhe county where the property is located. ���
Filing Dates: 1J Real Property: Dunng the 12 months before June 17 of the year the deduction is to be e(fectjv�eK� � q 7 ���
2J Mobile Homes assessed under IC 6-7.1-7: Between January 15 and March 2 of the year theP �'duc ort'is`to be ellective.
See reverse side for additional instructions and quali�catlons. __ � v_
�r cor�act buyer - see strictions on rev�se side)
number / legal descrioGon �°.°cord number O
oK
Page number
ssessed value of real property as of MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equftable
arch 1, curtent year March 1, current year ownef? ❑ Yes � No
o`� i �S�a
no, what is his / her exact share of interest? It owned with someone other than spouse, indicate with whom.
name on record is difterent than that of applicant, indicate below: Is the property in question:
❑ Real Property 0 Mobile Fbme QC G1.1-�
�ie of moRgagee or contract seller _ . D �
of mortgagee or contract seller I
or other owr
Does applicant own property in
wunty in Indiana?
approved in the
stieet, city, state, ZIP
��1
� this deduc6on been requested on
.�erty for wrrent year? Q YesO No
20 �_ 20 �I � � oC-/-c� � �-UV , d 0 -
iignature °
� We certify under the penalh n
�:sident of Indiana and owne
20
that the appticants was / were
rerson authonzed by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person