HomeMy WebLinkAboutMortgage_Tichenor (2).�.�•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES� C n hip Year
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� FOR DEDUCTION FROM ASSESSED VALUATION
Stale Form 43709 (R8/ 2-07) MAIi 2 5 009
�� Resaibed by Deparlmenl of Local Govemmeni Fi�nce
INSTRUCTIONS: `-�yn� � �File MaAc
To be filed in person or by mail with tfre CountyAuditor o/the county where the property is located. (/ �
Fding Dates: 7) Real Property: During the 72 months befae June 11 0/ fhe year the deducdon is to be e�lAfa9N COUNTY AUDITOR
2J Mobile Homes assessed under IC 6-1.1 J: Behveen January 75 and Ma2h 2 0/ the year tha deducGon is to be eflecfive.
See reverse side /w addi6onal instructions and qualifications.
w mntrad 6uyer - see rejVicfipns on rpverse side)
�AO I M °f" �D Ui n ir d
�ri - Key number / lagal desaiption
o �
value of real p erty as of Alarch 1, aarenl year Alortgage / ConVad
anent year �
/. �.
his I her exad
�me on record is tlifferent Ihan ihal of applicant, iMipte below:
Name of mortgagee or contract seller
AOtlress at mortgagee a contraa seller (num6er a�rtl sUeef, dry. sfa(e.
J
Name of assignee or Mhm owner or hdtler of mortgaga
Address M assignee (numbe! aM sUeeL dry, #ate, and ZIP mde)
Daes aPWicant own propeM1y in arry olher N yes, what
counry in Intliana7
❑ Yes ❑ No
Remid number Pepe number
a� 9 ���
of March 1, Is �ha appGcanl Ihe sda legal or equiUde owrn
spouse,
❑ No
�perty in Queslion:
PmpeAy ❑ Mobile Home (IC 61.1-7)
❑Yes ❑ No
COUNTYAUDROR
Deduction approved in Ihe amount of:
�s� aa - a-i ia. o
20 2(1 _ 2� _ 20 � 2� 2� _ 20
SynaWra of Counry Audrtor Cwnry Da1e (mmth, Eay, yeaq
1 I We certify under the penalry oi perjury ihat ttie above and foregoing intortnation is W e and corted and Nat tlie applirants was I were a resitlent of
Indiana and owner f Ne atoremenGOned property on March 1, 20
S" naWre (owners /ull ' �h , Dala (month, tlay,Yea�
� I ��
rasident a ress o, irant (numbe and sfreet. cdy. stale. erM IP code)
' ` 9 � �J. �2ov S . , � � iv,n �r1 � �c�
Person aulhonzetl by duly exeated Power of Altomey w by IC 61.1-12-.07 Dele (mmN, Cay, yea�
Address of aulhaaetl persan (number aM s7eel. aty. stafe. aM ZIP mOe)