HomeMy WebLinkAboutMortgage_Lundberg.A. � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE� n T ship Year
,,... .� FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fartn 43709 (R8 / 2-07)
's•; r Presaibed by Departmenl o( Lacal Govemmmt Finance ZO 8
File MaAc
INSTRUCTIONS: �/��
To be filed in person or by mad wdh the CountyAuditor o/ fhe county where the property is located. �6� ���"""•J,
Fding Dates: 7) Real Property: Dunng the 12 monfhs belwe June 77 0( the year the deduc6on is to 6e elfec6ve. U V �rr�p
2) Mo6ile Hames assessed under IC 6-1.1-7: Behveen January 75 and March 2 of the yegq�G6Bbi�y� Yo ��flEMi "ve.
See reverse side !or addi6onal instructions arrcl qualilcations.
qppirant (owner
!:a
i'd /nn Key num6er � al desaiption � Recoitl number P�3 S3
:t/�!�lc.t " ��- a-(�s-ldo-bv�- � a-oa �
'sed ralue of real papaty s oi March i, arrenl year Mor�qage I Con4act intleWedmss unpaid as of Marc� 1, Is lhe appfimnl ihe sole legal « equitable owneR
wrtent year
� �00 ❑Yes ❑No
wha� is his / I�er exaG share of inte2st? If wmed wi�h sort�eona dher �han spouse. fntlicale with whom. �
If name on recortl is dAferent ihan ihat
mortgageeorconUacl
morigagce or mnUacl seller (number arr0 sVeet dty. siate, eM ZIP rode)
alher owner w holder of morigage
Address of ass .
o�a�,,;��, DrawerNO..��,
counry in Indar �. - . . ••.
Card NO. .�.3j,3 1
Deductionappr GZllafUT�d 1""��•l.lJ.�•
u ZJ—�•
2q . O l � 20 � 20
VJhat Tazing DisUiclT
)UNTY AUDITOR
20_ � 20_
Is Ihe property in queslion:
❑ Real Property ❑ MoWe Hrnrne
20
����� a� �
❑ Yes ❑ No
20
� a��yq�tl� f I Cwnry I Dale (month, aay, ea�
, :_9.�_.� 0 8' � l- O�
I/ We c rtify un the penalry of pe �ury Ihat the above and toregoing infomiation is We and correcl and that ihe applipnts was I were a residenl of
Indiana and own of the aforementimed propeAy on March 1, 20
Dale month, day. yea�
�naWre (owne/s fiAlname) (
\
� residenl address of applicanl (num6er and stleeL dfy. state, aM ZIP cotle)
Person auttwrized by duty ezecuttd
a by IC 61.1-12-.07
persan (numberand slreet cRy, stafe. antl ZlP mde)
day yea�
1