HomeMy WebLinkAboutMortgage_Bradley�ei a� STATEMENT OF MORTGAGE OR CONTRACT INDfEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION Count 7ownship Year
�j+ Siate Fortn 43709 (R6 / S-06) ' ' • � '
� Presrnbed by Deparimenl of Local Govemment Finance
To be�iledTlOP Sson or by mail with the County Auditor of the county where the property is loca� ���M�
Filing Dates: 1) Real Property: During the 12 months before ,lune l7 0/ the year lhe deduction is to be ef(eclive.
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o(the ye�� �d{�c%��S to be effective.
See reverse side fo� additional instiuctions and qualificafions. �-y,, �t �/
. . O�la�n N/J°-�.
Applicant (owner
reverse
Taxing Distrid .' ��// "`' Key number / legal desc' on Record number ��
� � �/�, �Y`�G� L V a G - l �'-/ -aa7 ./� aV ��ber � /3 n
'7 7 �
Assessed value of real property as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ' `❑ Yes ❑ No `
�70 oa� � �
If no, what is his / her exacl share of interest? If owned wilh someone other than spouse, indicate with whom.
name on record is difierent ihan Ihat ot applicanl, indicate below:
�me of mortgagee or contrad seller -
! • - ' - _S�, �• ..
Address of mortgagee or contract seller (number and street, ty, state, ZIP
Name
or olher owner or holder of mortgage
assignee (num6erand st2et, city, state,
❑ RealProperty
❑ Mobile Home (IC 61.1-n
Dces appliwnt own prope —axing Distnct? Has this dedudion been requested on
counly in Indiana? DCa�ti'er i\'�., (� �]. LI� �^ property for wrrent yea(?� Yes� No
.0 ....7..... �
Card �\'O.
approved in the amu��.. _ _
20 � 20 �
� P
Signature
.......— ....
••••• fOR
20 20 20
County Auditor
20
Date
20
certify under the penalty of perjury that the above and foregoing information is true and corred and that the applicants was / were
ent of Indiana and owner of the aforementioned property on March 1, 20
(owners full name)
jCent address of
�lo� l.r•
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person