HomeMy WebLinkAboutMortgage_Keown°•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
_,_ FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (Re l 2-07)
�� ���� � Resaibetl by Deparlmenl W Local Govemmenl Firunce
File Maric
INSTRUC770NS:
To be filed in person or by mad with the CountyAuditor o/ the county where fhe property is bcated. g�
Fd'a'g Dates: 1 J Real PropeAy: Dunng the 12 montlis belore June 11 0/ the year the deduction is to be ef(ec6� ��� N B
2) Mobile Homes assessed /mder lC 6-7.7-7: Befween January 15 and Maiclr 2 0l the year7he U is be e v.��
See reverse side la additional inshuctions and qualificafions.
Applicant(ownerdmrNrad - re � 'onsm/eversestde) JUL 2
N
'�O' 'd _ ey nu= / legal �:scription rd nu � Page number
_� -�o.��s-oa6
hssessed vdue of real poperty as oF Maich 1, aarent ypr Martga9e / ConUact indeMetlrress unpaid as of March 1, I ui de avneR
artent year ^ n �„` ,� �
is his / har exaU share M inlerest?
If riame on iecord is ditferenl Uan
Name ot rtartgagee or caitraG seller J
�—!�
Address of moM1gagee w mnUad seller (num6er arM sfreef, o`ty, stafe. aH ZIP co0e)
Name of asagnee a olher a.vner a hdde� af mortgage
Address of assgnee (nu�er arM sGeet, �
Doe^ applicanl Oxn property in any olher
counry in Indianal
❑Yes ❑No
DeduGion aPPmved in lhe amount
F�d
SignaWre of Coun�ylwdiior
�
ZIP aode)
If yes, what counry7
COUNTY
20 20 _
1 I We certify under ihe penalty of perjury tliat the above and foregoing in
Indiana ownerof the afwementio cfd property on March 1, 20
S9 a a name) / l
iQenl dd_r appl�(number n�etdty.s�. ZlPmde)
� { (/
Pgmn autlwiized by duty ezeated Po,ver of Attamey n by IC G7.1-12-.07
Adtlress of aulhwaed person (nurtt6er eM sGeat rVy, sfafe. arrd ZIP m0e)
it owned wdh sortieor�e o�her Utan spouse. i�cate wlih whom.
Is ihe property in questim:
❑ Reai Property ❑ Mobile Home (IC 61.1
Has Iha dedudia� been requesled on property
for artenl yrafl
❑ Yes ❑ No
K �-�,-r-
a d��- 3so�
2�
day, yea�
: I were a resident of
Date (montA. Oay, yea�