HomeMy WebLinkAboutMortgage_Lamey (9).f-�—"! STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
��... _= FOR DEDUCTION FROM ASSESSED VALUATION (
State Farm 43709 (RB / 2-07)
�O �y •� Prescribed by Oepartment of Local Govemmenl Finance
File Mark
INSTRUCTIONS:
To be filed in person orby mail wdh the CountyAuditor olthe county where the property�is /ocated.
Fding Dates: 1 J Real Properfy: During the 12 months be%re June 71 of the year the deduc6on is to be ellective. ��� �
2) Mobile Hames assessed under IC 6-L 1-7: Behveen January 15 and March 2 of fhe year the d 6on to rve.
See 2verse side 7w addifional instructions arnl quali�cations.
Appirant ( whe� buye� - see �ricti s reverse s3e�n _
ud �slri — Key ruwmber / legal desaiption
U
d value of real property as d Marth 7, mrent y�r I Mortga9e I
airtent ye�
' what is his / her ezact share of inlerest7
iame on recwd is difFaenl Ihan Uia� of applitant, indiple below:
Name of nwrigagee orcanUaU seller
AOO.ess oF rtarlgagee w oonvad sNler (num6u aiM streef. dty. s}afe, an0
Narne of assg�e m dher owner or hdder of mortga9e
Does applicanl wm property in an
counry in Indiana?
❑Yes �
,.•
I / We berti(y
Indiana and ov
uialure (owners
w ��
2a�
��
� pen:
the at
ss of applicant
E ja �
by rn,y e,�e«n
;6tedness unpaid as of March 1, Is U�e applicanTlFie�sofe re�3YJrc4fGltade owneR
O Q �� ❑ Yes � No
If owned with sart�ed�e Wher Ihan spouse, inCirate vnlh whom. '
Is the property in quesGOn:
� ❑ Real ProoeM1V ❑ Mobile Fiorne (IC G7.
(�AN�� �
� ►� G� � L- �) M ��
08-- �a 3�0
Adtlress of author¢ed person (numberarM s4ee1, aty. state,
IHas lhis tl�
for arrenl
20
been requestatl on WWeM
❑Yes ❑ No
20
� i ax��o�
�ned and Ihat the applic�an6 xas I were a residenl o(
Date (rtronth, day, yea�