HomeMy WebLinkAboutMortgage_Mizeur.r'*q STAIEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION °— �
_ ,
Stata Form 43709 (RB f 2-07) N >, p^4 �y t
S,,,, 1 Presabed by De7artment of Laal Go�emment Finance !1 1ie.s �.�•_.r
iNSrnucnoNS: F �� ia`f` ZiiO�
To 6e frled in person or by mad with the CourrtyAuOitor ol the cnurtty where the property is bcated.
Fd'a,g Dates: i) Real Proparty' During the 12 rtronths before June 71 W fhe year the ded�tion is to be eflactive. ����--���,,, """'''
2J Mobile Homes assessed Imde! IC fri.l-7: 8ehveen January 15 and March 2 oi fhe yeai the deducGon is to b��Q�
See reverse side fa addtional insWctions a�M q�lifications.
616SON COUNTY AUDI70R
Appicarit (ouner u contrad dryer - see re�iCtians ar revarse side ,
Tadng ..A Key mimber I ie9a� �P�� Record iumbel Page mimbar
- o O� I
w�d �„e or,eai �y ��r r,�,d, �. a.,em y�� Morigage / Conlract iMebtedness unpaid az of March 7, Is U�e applipnl lhe sde legal u equiUde awne(7
ainent year
5 ❑ No
If at is his I her exaG share of iMerest? If awned wiU� someone dher Ihan spouse, indicata wilh whom.
If reme on recond is d'Aiereru than Nat of applican4 ��imte balav: Is e propeM1y in question:
�I Property ❑ Moble Home QC 61.1-7)
Name o�gea or omVact seller
Address of rtqilgagee a mnUad seller (number and streel dty. sfete, aM LP code)
Narne of assignee « Wrer avner or hdder W mwigage _ �-�-�
Address oF asvgnee (rcmbei aiM sfreel. dry, 9afe. and Z/P wde)
, ,��T�, 05�, � a.9�.�.�-�
Does applicaN rnm popeny in arry dher If yes, whal county. 9 D l� �\�' Cl� � O••
counfj in Indiara? - '
❑ Yes ❑ No �
C:ll'(] �� . .....................
COUNTYAUOITOR � �
Deduction approved in the arnwnt of:
2p � 20 20 20 20 _ 20 _ 20
SigreWre of hlwdMr Counb Oa�e (rm�fh. day. yea� I
i I We certi(y under the penalty oi perjury that the above and fwegoing infortnatb� is We and coRed and ihat the appGdnis was / were a resident of
Indiana and own of the aforementioned property March 1, 2b
S' ns4ue � � Daie (man(h. daY Y��)
r � Q
uo iestlent address oi appicant (number end s cdy, state ZIP mde)
S. Co.v cor�.a .�12 Q-�'tic �u 6 U
Person aulhorized by duN ��ted Power of Altorrrey ar by IC 61.1-12-.07 Date (month. Oay, yea�
Address of authoraed persai (number arrd sGee( tity, state. aM Z/P wde)