HomeMy WebLinkAboutMortgage_Hix.+. °—•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_,. � FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn 43709 (R8 / 2-07)
��� Prescnbed by Depariment of Local Govemment Finance
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INSTRUCTIONS:
To be (led in person or by mail with the CountyAuditor o/ the county where the property is loceted. - � E C � g Z�O$
Filing Dafes: 7) Real Property: Dunng the 72 months before June 17 0/ the year the deduction is to be eRecUve.
2J Mobile Homes assessed under IC 6-1.1-7: BeM1veen January 15 end March 2 of the year the deduction is to be eflective.
See leverse side /a additional insWCtions and quali(cations. `�-yj� ��
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4ppiica (ow er r mn7ad 6uye� - see re 'cG reverse si0e)
Taung Dis 'U Key n 6er I egal desaiption
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Pssessed ralue of real propsly as of MarCh 7, am:nl yaar MOrtgage / CqnVa
airrent year/
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whal is his I her exad share of interesl?
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If name on record is different Ihan ihat of applicant, iMicale below:
Nartre of mortgagee ar coniract sellern � � , �
indebledness unpaid as of March 1, Is the appticsnt Ure sde legal or equiUde owne(1
� ❑Ye5 ❑ NO
If owned wiTh someone other lhan spouse, indicate wilh whom.
Address of moM1ga9ce « mn�racl seller (numyQf antl slreeL oty. �ate. and LP crotle)
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Nartre of asegrree w Wher oaner or hdtler of morigaga
Address of assgnee (n�unber arM slreei. dty. state. aM ZIP oode) • _ `�
Does applicanl own property in any olher
n��5c11
couMy in Indiana?
❑ Yes ❑ No �QR�.��(�( _
�m �nar-� �JD�-EJt =
Deduction appmved in lhe amounl of: �/ pl „�y� �'� l' 7n4 '1 �
l0 I 1.�. � . � l.q
zo � zo `�Ud 8�P l 8'O zo
Is lhe property in question:
❑ Real Pmperty ❑ Mobile Home (IC 61.1
Has lhis deductim baen requested on properry
for curzenl yeaR
❑ Yes � No
L���
Y��
I I We certify under the penalty of perjury ihat Ne above and foregoing infortnation is true and cortect and Uial the appliwnts was / were a resident of
Indiana and owner of the aforementioned property on March 1, 20 .
Person authorized by tluly exE
Addrms of aWMraed person
� � and sheef. cR fale. aiM ZIP m
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�e, o� u�ey a by iC �t.t-t2-.o7
and s7reeL aty. sfale, end LP w0e)
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