HomeMy WebLinkAboutMortgage_Thompson (3).•�* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE�S� iCoun T ship Year
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� FOR DEDUCTION FROM ASSESSED VALUATION �-� � �
� State Fwm 43709 (R8 / 2-07) 1L
�° ;:,. '� Prescribed by Departmenl of Local Govemmenl Finance
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� � V'File MaAc
INSTRUCTIONS:
To be filed in person or by mail wfth the CountyAuditor of the county where fhe property is loceted. ��
Fding Dates: 7J Real Property: Dunng lhe 72 months before June 11 0( fhe year the deduction is to be eflectl e�. 6� �
2) Mobile Hanes assessed under C 6JJ-7: Betwean January 15 and Ma2h 2 0/ tfre yeG'BSON CO ry1� vo be��{qe.
See reverse side /a additional instruttrons a� ualifications.
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description
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If rome m record is drf(erent Ihan Ihat ot applicarrt, irWiqle belaw:
Name of mortgagce or conlract seller
Address of moM1ga9ee w mnlract sellei
Name of asslgrree w dher owrrer rn
(number arM sGeet. dty, slate. erd LP mAe)
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Ooes appliwnl own pop � — If yea, whal counry7 � WI
couiuy in Indiana7 � ��
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DI'�11'Cl" 1�' Q� _ __. U
�...... , .
Deduction approved in • • . . . . . . ..
Card 1\`O. ��/�/ —
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�, � "� • �3 . �" '(;$;vo'i; t�� . . . ^
030�-[
id as of March 1,
sae �ega� a equitable ovmer
❑ Yes ❑ No
someone other ihan spouse. indicafe wiih whom.
zo
Is Ihe properry in quesUon:
� Real Pmperty ❑ Mobile Home
Has Ihis deduGim been requested on property
for curtent yea/?
❑Yes ❑ No
zo _ � zo _
yea�
I/ We certify under the penalry of perjury tl�at the above and foregoing infortnation is true and mrrect and that tlie applicants was I were a residen[ of
Indiana and owner oi the aforementioned property on March 7, 20
,rw �rw rn:urerc hAl namel Dale (rtanfh, daY.Yea/)
�I residern adtlress of applicarK (nu ber and street. cdy. sfafe. aM P wde)
°(14 11, C.cK'�f��t�� (���--��n
Person authonzed by tluly executed Power of Alinmey a by IC 61.1-12-.07
Address of a��Mr¢ed person (number and sbeeG dty. stafe. erW ZIP code)