HomeMy WebLinkAboutMortgage_Stilwell (2)• . y. . . . .1 ,•�,: �. . .. i .., .....+'Lt' , ; -:r... . _-r'.i'�i-+. �... . ^' �'1�
� _ �. .
/�y � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�i' = FOR DEDUCTION FROM ASSESSED VALUATION
•; .� SUte Fwm 43709 (R6l 5-06)
1u.
Resai6ed by OepaNnent af Loml Gwemment Finance
INSTRUCTIONS:
U�'
To be �led in person or by mail wrth the County Audito� of the county whe�e lhe property is located. �
Filing Dates: 1) Real Property: During the 12 monfhs before �une 11 0/ the year the deduc6on is to be eflective. � �
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and Ma�ch 2 of the year the d�ucGo Sis tobeSeflective.
See reverse side for additional instnictions and qualifications. �N
G���
G�gS
ryr:
Applicant (owner or caotract 6uver -
Taxing Distrid
Assessed value of real property a� of
March 1, wrrent year
If no, what is his / her exact share of interest?
on reverse side)
Key number / legal description Record number
aG -ia.-�o--S%o-�o5!d�G-oa
�/ � Page number
l0
o - a4ag�-oo - 3
MoRgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, cunenl year ownef? ❑ Yes ❑ No
If name on record is different than that of appticant, indicate below:
of mortgagee or contrad seller
Address of mortgagee or contrad selier (number and
Name of assignee or other owner or holder of mortgage
Address oi assignee (num6er and st2et, city, state, ZIP
If owned with someone other than spouse, indicate with whom.
Is the property in
ZIP
❑ Mohite Home QC 61.1-�
- -- -- �C �w`l� cs ��/� �
Does applipnt own property in any other If yes, what coi esled on
counry in Indiana? Yes� No
� �C�=(o-I-�
20
Signature
approved in the amounl of:
���-i3�7
G
'/ We ceAify under the penaity of perjury lhal the abovf
a resident of Indiana and owner of the aforementioned'
�-�-t c;�c�e �/
Person autnonzea vy uuiy o.�...,.�.. � ....... ......._.._,
or by IC 6-1.1-12-.07
person
W
as ! were