HomeMy WebLinkAboutMortgage_Morrison (4).� N* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
_ FOR DEDUCTION FROM ASSESSED VALUATION
Slale Fortn 43709 (RB! 2-07)
S � Presmbed by Departmenl d Local Govemment Finance
WS7RUC710NS: �
To be filed in person w by mad wdh the CowtyAuditor o/ fhe couMy where the pro�� 1�
Fd'mg Dates: 1 J Real Property: Dunng the 12 months be/ore June 11 d the yeai th� on �.s fo be elfective.
2J Mobile Homes assessed under IC 6-1.1-7: BeAvaen January 15 and Maich 2 oRgy @grfn�duction is to be effective.
See reverse side (a additional ins6uctions and qualifications. AP G �
Appicarit (awner� Wryer'see �s�jGtions verm side) n ... _ � `J77,.�.,
( ��
Psscsed ralue ot 2al popely as of March 1. amenl yrar MorlOage I(
artentyear
U�al of appluxnt, indiote belav:
mortgagee or canVad se�ler
AddrPSS of mortgagea or mnlrad seller (number aiM �
Name oF assipnee a otl� aaner or hdder of mMga�e
city, slafe. aM
unpaid as of March 1,
If awned wilh someone
��'i��� °'�m���an� Dra���er NOa.CIi.</u••• °��D/
�
❑ Yes ❑ No � � �
0
Card N�. . L//.�....�/� 60
YI 1112 dTWN Oi: �� I���"TT SW
�9"�"° �,.�.�
,---�
p � tU _ , 20 - 2�
Counry
. Remr�ny�per
V �
Is Ihe applinnlUre sde It
spouse,
�
❑ Yes ❑ No
is u,a w�m tn a��a,:
� Real Property ❑ Mobile Harie QC 61.
Haslhis tl�
fw arrenl
20
oate
��t�a o� a�r
❑ Yes � No
20 _
I/ We certfy under ihe penalry oi perjury ihat the above and fwegoing information is We and correU and that the applirants was / were a resident of
Indiana and owner of the afwementioned property on March 7, 20
�e (mvne/s IWI name) Date (monN, daY. yea�
dly.
by duly e:ecuted Power of Atiorney w by IC 61./-12-.07
eed persm (num6er arM shee; cGy. sfate. arnd ZIP oo0e)
/ � �
Dale (imnfh. QaY• Y��)