HomeMy WebLinkAboutMortgage_Harpe.r�o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
:,��... ,; FOR DEDUCTION FROM ASSESSED VALUATION
�" S�ale Portn 43709 (R8 / 2-07)
'6 �' Resmbed by Depariment of Local Govemmenl Finarice
� I �F���
INSTRUC7IONS:
To be filed in person or by mail w8h the CountyAuditor of the county where the prope�ty is located.
Filing Dates: 7) Real Prope/ty: Dunng the 72 months before June 71 07 the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6JJ-7: Behveen January 75 and March 2 o/fhe year the deduclion is fo be,eflc(�6y�U�
See reverse side /or additional instrucGons and qualifications. S EP 1�+ �
Nppilcant
on
G.�i
Year
gOisln'ti �� Keynumberllega},(i�/�' /� ���—oOO. ������BS O AV F�bS@numb �
f ��
:sed ralue of mal properly as of March 1, cwrent y�r Mortgage I cl iMeWedness unpaitl as of March 1, Is ihe appfinnt �he sole legal w equita6le owneR
°'rt�"��C� 800
❑Yes ❑ No
whal is his / her exacl share of inlerest? If owned wilh someone olher �han spouse, indirate with whom.
c
rtartgagee or conUact selier
Address of mortgagee or conVact seiler (number arM 9reet dty. stale, aM LP code)
Name of assgnee w olher owner or hdder of morigage
�
-
Address of assignee (rn�m6ei arrd slree; city._a^"
OeducSoi
� �
SynaWre of i
«- ���Q�,. .3.9j3 �
Dra���er r'O'
CaYa ��
Wfa1 Tacing Dislnc
COUNTY AUDITOR
20 20
Counry
Is 1he properiy in ques6on:
❑ Real Prucertv ❑ Mobile Hrnie (IC 61.
� qti-�IIFlS
deduclion been requested on property
n� yea/?
❑ Yes ❑ No
20 20
I( We certify under Ihe penalry of perjury ihat Ihe above and foregoing infomiation is Vue and correct and that the applicants was / were a resident of
Indiana and owner of the atorementioned property on March 1, 20 "
Ipature (own�Ys /NI name) � \ n _ Daie (rtanlh. daY Y��)
state. a�M Z!P mde)
aulhorized by duy executed Power of Nfaney w by IC 61.1-72-.07
Address of autlronzed person (numberaM sfreeL
Date (monlh. day. year)