HomeMy WebLinkAboutMortgage_Monier.•�'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,, . � FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (RS! 2-07) �
�'';- •� Presaibed by Departmenl of Local Govemment Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the CountyAudiror o/ fhe county where fhe property is located. - � E C 1 5 Z��B
Filing Dates: 1J Real Pmperty: Dunng fhe 72 months 6e(ore June 17 of the year lhe deducGon is to be elfec6ve.
2J Mobile Hanes assessed under IC 6-1.1-7: Between January 15 and MarcA 2 of the year the deducUOn is to be_�ff _ecUve.
See reverse side Jw additional insLuctions a� qualifications. ���Q%��
Applicant (own a mnhad Wryer - see restrictfons on reverse sidE)
lti/
a�drgDisipti Keynum � r/Ieg desaipibr
As(s�essed ralue of mal poperty as of March 1. amenl l�� �9a4
�3/�—1 t-!q - y- i• aRs anent
f,e. whal is his / her �aU share af interesl?
If name on record is diRerent Ihan �ha( of applicant, intliple belav:
Name ot rtqrtgagee or conUaq seller
Atltlress of rtaM1gagee w mnlrad seiler (number arrd sLeef, tity, sfa(e.
Name of assignee w other oarier « holCer of mongage
ACtlress of assignee (number ard s4ee1, aty. slafe. end ZIP cotle)
,i
Does applicanl own property in eny olher '.�i
counry in Indiana7 '-;j
❑Yes ❑No �:i
�{
i
:i
Deduction approved in lhe amount of:
i':
1
� �
+l� C
as of March 1,
o.med wN� someone ather ihan spouse, indicate wiih whom.
Dra�ver NO. �0..-.. �O � ��
Card 1�'O . ............. �.
Counry
« equiude ownen
❑Yes ❑ No
Is Ihe property in question:
0 Real Pmperty ❑ Mobile Home (IC 61.
Has Ihis deduclion been requesled on property
fIX aRen1 yea/1
❑Yes ❑ No
20
2� _
I I .. '; '
I I We certify under the penalty oi perjury tliat the above and twegoing infortnation is We and mrreG and that tlie applinnis was / vrere a resident of
Indiana and owner of the aforementioned property on March 7, 20
,na�e (owne(s MI name — Dale (monN, tlay. year)
�
aulhonzed by duly executed
Pe�
end sheet. city. state. aM Z!P oo0e)
� �C— Fo ��
� or a�„ay « ny ic �i.�-i z-.o�
tl sbeeL cily. state. aM ZIP mCe)
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oa+e c��. �r. r�n