HomeMy WebLinkAboutMortgage_Lewis (11)i� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION nt T hi Year
'�/, State Fortn 43709 (R6 / 5-06)
� Presmbed by Departmem of Loral Gwemmenl Finance
1
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INSTRUCTIONS: `-yri_ _Fi��
To be filed in person or by mail with the County Auditor of the county whe�e the property is located. ���
Filing Dates: 1) Real Property: During the 72 months befo2 ,lune �l o/ the yea� the deduction is to b�QN�OUNTY AUDITOR
2) Mobile Homes assessed unde� IC 6-7.1-7: Between January 15 and March 2 ot the yea� the deduction is to be eliective.
See reverse side for additional instnictions and qualifications.
Applicant ner or contract buyer- see 2strictions on verse side)
�7�2'li/� �-�1 � LC�. `V' �G�.liStn�-� � GK-y?...G�i'C�
Taxing Di�StridU � G
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Assessed value of real property as of
March 1, current year
If no, what is his / her exact share of interest?
If name on record is di1
�e of mortgagee or
Address of mo gag�
Key number / legal description Record number ��O n
�6 -�8 -aY-ao� . t�
Page number
000 . v4 0_ o,z 6 ���-
MoRgage / Contract indebtedness unpaid as of Is the applicant the sole legal or ei
March 1, currenl year owneR ❑ Yes ❑ No
9 n, 3 So
If owned with someone other than spouse, indicate with whom.
that of applicant, indicate below:
seller
ar conhad selier (number and street,.aty, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amounf of:
20�� 20 /
1 r
Signature
Is the property
❑ Real Property ❑ Mobile Home (IC 61.
��g- ia y a
� 90, 350.�/
What Taxirn . � (i d ��-C
��rn�oa.c,�� J
COUNTY AUDITOR
20 20 20 _
County Auditor
i1 �
� •�
� � !,. .
Date
7. "
certify under ihe penalty of peryury that the above and foregoing information is lrue and corred and that ihe applicants was / were
leni of Indiana and owner of the aforemenlioned property on March 1, 20
ue (owners (ull name) Person authorized by duly ezecuted Power of Attomey
�%, , , �� �_ � or by IC 6-1.1-12-.W
%
of aulhorized person
t
lo