HomeMy WebLinkAboutMortgage_Luse"°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fpm 43709 (RB / 2-07) -
S � Prasrnbed by Depsrl+rient d Laal Go�emmaG Finence
Fle Mark
INSTRUCTIONS:
To be fiied in person w by mad wrth the CountyAuditor ol tfre county wheie the piopa,ty is located. M/aY ] 2 2��9
Fd'vig Dates: i) Real PropeAy.� During the 12 months befare June 17 d Ure year the deduction is to be eBeclive.
2) Mo6de Hames assessed fmder IC 6-1.1-7: BeMeen January 15 end March 2 07 Me yea� the deductim is to be e8ective.
See 2verse s�e fa eddtional instrucGons and qua/ificaGons. `�-j/� ��
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��vW�^�(ow^� b�er-see!� �a+�reyy�gde> OIBSON COUNTY AUDITOR
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iria . Key number / tegal desaiption
- I - 00 -� . -G -
value of real propaq as d Mardi 1. anerd Year A/«iga9e / Conbad indebtedness unpaid az of March
aneu year � /'O
v
I is his / her eze�Y share o( iMercst? 1/ wmed with mmeone
If r�.Tie m recad is EiftareN ihan t�al of epplicarq, indiote belo.r.
Name af mortgagee or c«Nact selle� /�
nm.ass o1 mongagee a omtraa se��m (nmeer ane streeC dA: swe.
a
�aress m assgr�ee,nanoe, ana:veec rnr. sra�e. em ur mae,
Dces ePP�icaM oan poperty in arry dher
�,� � �����
n ❑Yes ❑No
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Ifl VIC BRiWl1l OF.
If yes. whel counl� Whsl Ta�dng
COUNTYAUDR R
zo � zo — � 20
�«+Mr
zo
Rxord rwmbel Page rwmber
a �n �7 1 a.�5
b
Is Ihe appGC2nt Ihe sde lagal or equitahle wmefl
❑Yes ❑ No
spouse. indicate wiUi whom.
rIs �the propeM1y in questim:
�ral Property ❑ Mo67e Hane QC 61.
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I/ We certity under the penalry of perjury that tt�e a e and foregoing infortnation is true and corred and tliat ihe applicants was / were a resident oi
Indiana and o-y-.��r of fhe aforerty�_entiya�propert�i March 1, 20 _
t�LVe (lmrls.IUUneme) .i// Date (mmM. daY.Y��)
dfy, sfafe. aM
aulhor¢ed by duy exealed Pw.er of Pltomey or by IC 61.1
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