HomeMy WebLinkAboutMortgage_Hamess'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_. FOR DEDUCTION FROM ASSESSED VALUATION
� SUte Fortn 43709 (RB! 2-07)
�' �` Presrnbed by Departmenl of Local Govemment Fi�nce
File Mark
INSTRUCTIONS:
To 6e filed in person or by mad wdh the CourrtyAUditor o7 fhe county whe/e the property is bcated. A U G ��[ u(7�
Fding Dates: 7) Real Pmperfy.' Dunng the 12 months before June 11 of the year the deduction is to be e�fec6ve.
2) Mobiie Homes assessed under IC 6-7.7-7: Behveen January 75 and March 2 01 the year the deduclion is fe eRective.
See 2verse side fa additional ins6uctions arrd qualificafions. a���
T DisUia Key nu
�b-1 -3�
ed value af real popaly as d March 1. <
I'�iat is his / her ezacl share af interes�?
If reme m recmd is tliRerad Ihan ihal of appl
Name of morigagee ar conlrxt seller
m reverse side)
' V • 7oC'Va
Mor(ga9e / Coniract iMebtetlrress unpaid as M March 7,
wrrent vear . .^.�
Address of mortgagee a mnUad saller (number arM �eel,
or oVx.+oancr or hdder af marigage
Atltlress of assgnee (muMel arrd sUeet,
Does applicanl own propeMy in arry dher
caunry in Indiana?
❑Yes ❑ No
DeduGion appioved in ihe amounl of:
�
SignaW re of Counry AudMr
0
mmed wdh someane olher �han spouse,
el
If yes, whal count�? VJhat Ta�wg OisUx
COUNTY AUDITOR
20 20 20
CWnIy
�mber Page number
sde leoal w eo table avneY.+
Is �he property in ques6m:
❑ R�I Propetty ❑ Mobile Harne QC 61.1
Has ihis deduction bern requesled on properry
fw artent yeaR
❑Yes ❑ No
20
Dale (�(h, day, yea�
20
1/ We certify under ihe penalty of perjury ihat tlie above and foregoing infortnafion is true and correct and tlial ihe applipnts was / we2 a resident of
Indjana and owner of fhe aforementioned property m March 1, 20 _
arM ZIP code)
���ow� ��� IC 67.1-12-.07 I Oate (�U+. daY. Y��
aW�a¢edpersan (num6eraMsfreeLcAy,s fe.andLPoode)