HomeMy WebLinkAboutMortgage_King (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ns r
__ : FOR DEDUCTION FROM ASSESSED VALUATION
• . .. � State Fortn 43709 (R11 / 609)
,,w � PresaiCetl by DepaRmem of local Govemment Frence
vsrnucnoNS: p� � Z��)
�b 6e filed in person w by mail with the CounryAWitor or Counry Rewrder o( the counry whele the property is located. F� �� ��
C.�
Filing Dates: 1J Real Pmperty: Must file durirg the year for which fhe deduction is soughL n ry ditor
2� Mobile / Manufactured Homes rrot assessed as Real Property: Must fiie dunng the twelve (72) months [] �(���n
before March 37 of each year fhe deduction is soughL GIB N CtlUIY � T �
See reverse side for add"Rional instn�cfipns arM qualifications. �
?,�� I aT�' �� �� -/OO_00/. O ;
ireal Woprlty as of I Mortgage / Contracl inCebteEness unpaitl as of
year Mard� t. artent year
I( ro. what ¢
It name an recOtd "s CiRe2nt Nan �hat o/ appli�ant. indirate b¢b�r
r�� or �,eny�� � �v� �oe,
PddteSS of mortgagee oroOntraU SeDer
� / �r
i ��i � G
�
�d��•- � �o �,�
o/��?� WPU� a'�, �
_ ���0�"� �Q�i�
�_ � l� U
De�u ��
20
Sigreture d Camh NMitor
20 _ � 20
a
�e /
someane
;` �. aM ZIP code)
� / � = �-,
W�at Taprg D�stna?
COUNTYAUDROR
20 20
eC6 II �fzf /
un7aiC as of Is Ne eGW�t Ne sak
legal a CWitable avmef?
� n Yes n No
pmperty in Vuestim: Mm�ely Assessed
eal Properry ❑ Mnualyl�ssesscW
Moa� r�«� nc �
Has Ihb dedudqn Deen reGueSleA on C�opertY
far artent yeaR r� .. r-� .
20 � 2(1
I/ We cenify under ihe penalry o( perjury Nat Ne above aM foregoing in(ortnaUOn is true and cortect arW that Ihe applirant is a resident of Indiana and
owner ! contracl buyer of the aforemefrtioned propeM1y on date apP�icalion is filed.
,run,r�'�jatqrers Lm ra,rre). ._ oace („nNn, ear. reen
Fu0 re3ftlAnt aEtlrYrNs of
stale,
Date (rtanN, daY• Yearl
Mdress ot aufhor¢ed person (numberaM sLeet, ri(y, slate, an0 ZIP mde)