HomeMy WebLinkAboutMortgage_Goforth"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun wnsh r
_ FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (RB! 2-07) t
�1 ` Aesrnbed by Departmenl of Locel Govemmerrt Fi�.e
��M
File Mark
INSTRUCTIONS:
To 6e filed in person w by mad wifh the CourrtyAuditw o/ the courrty where the property is bca(ed. �7f ��
Fding Dafes: 1 J Real Property: Dunng the 12 months be/ore June if d Mre year the deducSon is to be et7ective.
2) Mobile Homes assessed a/der lC 6-1.1-7: BeMcen Januery 15 and March 2 of G�e year Me deduc6o+R310S1$(�C TY AUDITOR
See reverse side for eddltional ins6uctions arM quafificetions.
�ol�n �
Ta ' D'strip�
�a.�-��1�0, I•v
Asessed value of real oro[
Lt'"-si
ryer' see rasnicfions m ieverse sde)
� r � d' S�}-ac ; C
Key number / legal desrripibn
aL-�r-�o- soo
as or Mamh ,. wrern rear M«cgase � c
ainerG year
- moU, 568- � ��
arNari indeMednass unptid as af Marr�h 1.
2� 14b0
I(awred with sort�eme W
If rvme m recwtl is differerd Ihan �hffi of applicant, in6�ale below:
Name of mortpagee or canUacl selle�
�i\Q.-s e
AdOress of mortgagee or conUaC sdler (number and stree4 �y. slafe. aM LP code)
Narne of assignee or dF�tt wrner w
Deduction
�
sGee; dty, stafe. erd ZIP rode)
ovm property in arry other
ia?
❑Yes ❑ No
wed in ihe amamt of:
� I N
yes,
� I �
Ta�dng Disirid7
20 _
f � ��J /o•z-�1 �•56�36
Rem�d number Page number
❑Yes ❑No
whom.
Is Ihe property in quasUm:
�R ,�af�roperty ❑ MoMle Hrnr�e QC 61.
Has ihis deduaim
ro. a,rrem yean
I 20
❑ Yes ❑ No
o�e �m«�m. dar. rea�1
20
I I We certiy under the penalty of perjury that fhe above and foregoing infortna6wi is true and mRect and that ihe applipnts was / we2 a resident of
Indiana and owner of ihe afwementimed property on March 1, 20
and s4eef, tlty, state, and Z(P oo0e)
Person autMt¢ed by duN ��� P�� °� ����i' a�' IG Fi1.1-12-.07
Addre^,s of aulhrnized persm (numbei antl sheeC dty, state, arM LP code)