HomeMy WebLinkAboutMortgage_Pohl°^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (R8 / 2-07)
�' y» � Presmbed bY �Menl d Lopl Go�emmeN Finante
� 1 ���
INSTRUCTIONS:
To be (rled in person or by mad with the CountyAuditor o/ fhe courrty where the property is bcated.
Fding Dates: fJ Real Property: During the 12 months be/ae June 17 d the yea� the ded�bon is to be eNective. AaN,�
2) Mobile Homes assessed under IC 61.1-7: BeM1veen January 75 and Maich 2 of the year the deduuppq�s �� eAq�lye.
See reverse side for addtional insbuc&ons end qualificatrons. ����� `�
>� K����„�����5ry3i-aaa-o�.�a8-aa� K��q r�,�.
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vdlue m real popaty as d March 1. anent year Martga pr��OO V as of March 1. Is the apPGfanllhe sde le�pl w aquitahle wmeR
cuneN G
«% ❑ Yes ❑ No
�at is his / her exaQ shere af inlerest7 IF wmed with someone dher Uan spouse, �cale vri�h whom.
m recorA is diRerenl Uw� lhat oF applicaN, iMimle belar. Is Ihe properry in queslim:
❑ Real Property ❑ MoGle Hane (IC 61.1
Name of rtnrtgapee or cmiracl sdler
Address of rtrortgagee a
and s6eef, oYy, sfate, aM
of mMgage
of assigrree (nm�er mM sGeeC �Y• �a.
Dces eppliraM own praperty in arry dher
cwNy in Indiarel
❑ Yes ❑ No
Yes. v�hat county/
WhalTe�dng Disbicl7
Q
arrenl
— 7��
uestea on pioperty
❑ Yes ❑ No
/^ 'AUDROR
Dedudion apprwed in Ne amwnt af: _ (,y
p p �o ��, c�"� i� _ Zo_ �_ zo_
�
sig�atura oi CounrylwdM P�' unry oate (mon t h. d aY. Y� �
1/ We certi f y under the b� '��� _-••�y infwma6on is true and mRed and tlial the appGrants was I were a resident of
Indana and owner of th ....�ui 1. ZO
Perso�
address of
city, sfefe,
ar by IC G7.
pasan (numberand stree4 r6y, sfafe, aM LP code)
�
Dale (month, day, yean
day yea�