HomeMy WebLinkAboutMortgage_Roach�' �
�.a.�'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
, . ! FOR DEDUCTION FROM ASSESSED VALUATION � � � � ,
State Form 43709 (RB / 2-07)
�O ; '� Prescnbetl by Departmenl of Local Govemment Finance
lNSTRUCTIONS: DECF�e ��08
To be filed in person or by mad with the CountyAuditor o7 the county where the propeAy is located. �
Filing Dates: 7) Real Pmperty: Dunng the 72 monfhs be/we June 77 0/ the year the deduc6on is to be eflecGve.
2J Mobile Homes asseased under IC 64J-7: Befween January 15 end March 2 0/ the year the deduc6on is �j'qJigcfi� �
See raverse side Iw dditional insWcfions and quali�cations. �� �
F Q� `NTY AUDITOR
Appicam (o er Mrad buyei - see � c" m reve side)
_ �.i,�„ r�/��, ��.,=/%'-%�i�=�it�_/5'S/iS/7-/��_/7�»�no
� l Key n ber / I desaiption
'/�L__ % L
propaty as of rU i. ament y�r MMgage
anenl re
�o, what is his / her exacf share of intert
If riame on iecad is diRerent ihan Nat of �
Name of mortgagae o coniracl sell
Adtlress of mortgagee a cmira el (r
Name ot asvgnee w olher ow�r or hddt
Address o( assignee (number eiM sVeeC �
Does applicanl own property in any other
counry in Indiana7
❑ Yes ❑ No
DeducUon appmved in lhe amount of:
20 � 20 _
Si9�Wre of Caunrylwtlilor
icant, indiole below:
� _—/ ' ! — _ —�
Ser an 9ree4 aty, sfa(e. arM ZIP cotle
mortgape
stafe, and ZIP code)
It yes, whet caunryl
COUNTY
20 — I 20
as
- Recoid number � Pa9e nymbqr�
� B g m�7
1, IS I�IB dPFS W1111118 SdC �B(�3� p 6QN�2d8 ONTCr
❑Yes ❑ No
It owned wM mmeone dher Ihan spouse.
w�ceM
❑ Mobile Home (IC 61.
D'atrict7 Has Ws deduqion been reduestea on properry
fw aneM yrv(+
❑Yes ❑ No
20 20 _ 20 _
Date (mmth. EaY.Y��I
I I We ceNfy under Ihe penalty of perjury lhat the above and foregoing infortnation is trve and correct and.Nat Uie applirants was 1 were a resident oi
Indiana and owner of the aforementioned property on March t, 20
�natur (owne/s hAl name) Dale (mmlh. day, yee�
� , �_o . ��, . . L`� ����C /�—�9 -Q�'
��II revdenl address of applicant (num0er and svaet. crty. s�are, ara ur ca
Person authwized by tluly exeatetl Power of Ntdney or by IC G7.1-12-.07
Address M aulha¢ed person (�umbar aM sUeeG cdy. sfate. and LP wde)
tlaY �A