HomeMy WebLinkAboutMortgage_Drury+�'� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
�J + State Fortn 43709 (R6 / 5-06)
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� Prasaibed by Department ot Laal Gwemment Finance
INSTRUCTIONS: � ��
To be filed in person or by mail with the County Auditor of the counfy whe�e the propeRy is located.
Filing Dates: 1) Real Properry: Dunng the 12 months befoie �une Il of the year the deduc6on is to be eKective. 7 n7
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of fhe yea� the ded�i8n r� f� He��fective.
See reverse side for additional instiuctions and quali/ications. �� ��
OR
Applicant (owne� or t2 t buyer - see r�Sh�ctions on reverse side) G�gSON C
Taxing District V Key numbe / I gal description
006 -p l S -b�
��or%a�.� a(o-Ic-0�-3oa-m3.
Record number
number
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applican[ the sole legal or equitable
March 1, current year March t, curtent year owner? ❑ Yes � No
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If no, what is his / her exact share oi interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
❑ Real Property � Mob�e Home QC 61.1-7)
mortgagee or contract
Address of mortgagee or contract seller
or other owner or holtle
:e (number and street, �
pplicant own property in any o
in Indiana?
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Signature
in the amount
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and street,
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County Auditor
�:trict?
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property tor wrrent year? ❑ YesO No
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Date
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I I We certify under the penalty of peryury that the above and foregoing infortnation is We and cortect and that the applicants was / were
sident of Indiana and owner of the aforementioned propeRy on March 1, 20
�,y�iature (owners /ull name) Person authorized by duly executed Power of Attomey
'� �b � ��,7i or by IC 6-1.1-12-.07
oen[aaaress oiappncanc IHooress otaumonzea person
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