HomeMy WebLinkAboutMortgage_Cummins.+^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co r own ip ear
�;°��� FOR DEDUCTION FROM ASSESSED VALUATION • �,✓
State Fwm 43709 (R8 / 2-07)
�° '- � Presaibed by Department of Local Govemment Finance
File Mark
INSTRUCTIONS:
To be lled in person or 6y mail wdh Me CountyAuditor of the county where the property is located. � �j��w ��
Fding Dates: 1J Real Pmperty: Dunng the 72 months befwe June 17 0/ the year the deduction is to be elfective.
2J Mobile Homes assessed under IC 6-1.1-7: Belween January 15 end March 2 o/the year the deduc6 be � e
See reverse side /or addiG'onal insbuctions and quali(cations. ��� �� ���L�Y� � AUDITOR
w mnVap buyer - see resVicfions m reverse
� � � ��
d�z � �c�a�c�.:i �d _
Assessetl value of real popelty as of MarU 1. arrenl ycar
�what is his / her ezact share of inieresl?
- /.�Y-- 3od -,000,
Mgage / ConVacl iMebtedness unpaid as
If name on recortl is ditterent ihan Ihat of applicant, indipte below:
Name of rtwrtgagee or mnLact seller
or mntract saller (n�mbei aM sVeef. tity, st�, erH ZIP
assigrree w olher owrrer or hdtler af mortgage
Atldress of asvgnee (number aiM sLeet, ctity, stafe. and ZIP oode)
oaes aaWicaM ow„ aoPerty �� e�y aner n yes,
counry in Indiana?
❑ Yes � No
-DoZlo
7,
If rnmed with someane olher than spouse, i�cate with whom.
0�0�
d equiude ameR
❑Yes ❑ Na
Is tha poperty in question:
❑ Real Properly ❑ Mobile Hame
DI'.1}����• l�i�'/7^ f� �C�1Ll
"K�/G./lJ 'v�i
�(� C:ll'v 1�`�. .. -
7���� Oc � ................
tT � O `� �ty
fp wrterrt yea� �
LJYes � �:o