HomeMy WebLinkAboutMortgage_Leible (2)�+�•n� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u ip Year
;, ._ � FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fwm 43709 (R8! 2-07)
�0�;� � Presaibed by DepaM1meni ot Local Govemment Finarxe MQ� y�oo
� File Mark
INSTRUCTIONS: .
To 6e �led in person or by mail with fhe County Auditor o/ fhe county where the property is located. � ���
Fding Dates: 1J Real PropeRy: Dunng the 72 monfhs be/ore June 77 o/the year the deduclion is to be ellec�q�s pNC �
2) Mo6ile Homes assessed undei IC 6-L 1-7: Behveen January 15 and March 2 0! the year the deducbon754���Ne�dtli�70R
See reverse s�qlw additional instiuctions arM qualifications.
/ � /1
-see
Key
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what is his / her exad share of interest?
sCe)
If name on record is difterent ihan Ihal of applicant, indinle below:
Name of rmitgagee or conUaq seller
mortgagce or mnlrad
rnvner or holder of mwigage
° / �-/e� -�!
4ate,
l9� oa�
i as ofMarch 1,
rith someone dher U
Adtlress ot assignee (n�m�6er arq sfreel. dry, state. aM ZIP code)
Does applicant o.m propeny in any other If yes, what counryl Whffi Ta�dng D'atricl?_ �
counry in Indare?
❑�e5 ❑ No c�G7
i
�o �Od9.:..........
Deduction appmved in the amount of: `%� p ra��• cr
�. ....
zo � zo zo _�;';� C�i d 1 O. ....� �48 3'.�5.
� ,, � ,
� W
iWre of CounryAud�nr �'±
^i
Remrd
Is �he applinnt Ihe sde legal
❑ Yes ❑ No
spouse,
Is the propeM in Question:
❑ Real Property ❑ Mobile Home (IC 61.1-7)
uested on poperty
❑Yes ❑ No
zo
Date (monN, tlay, yea�
�
I I We certify under the penally of perjury ihat ihe above and fwegoing infortnation is We and mrrecl and that the applicanis was I were a resident of
Indiana and owner of tlie aforemenGOned property on March 1, 20 .
resitleM adtlress of applicant (number and straet. cdy. stafe. and ZIP code)
S . !� n r�F e .�n
� executed Power of Atinmey a by
person (numberarMSLeef,city.state.aMZlPaode)
Date (month. daY. Yea�
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