HomeMy WebLinkAboutMortgage_Ray.n�•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count o nshi
>c,_. ,; FOR DEDUCTION FROM ASSESSED VALUATION
State Fam 43709 (R8 / 2-07)
�� �+ Presoibed by Dapartment of Local Govemmml Firunce
i a
INSTRUCTIONS:
To be filed in person or by mad wdA fhe CountyAudifor of the county where the pmperty is located. `-7 � ��/
Fding Dates: 1) Real Property: Dunng the 72 months 6elwe June 17 W the year fhe deduc6on is to be eNective. l�'� ��
2) Mobile Homes assessed under IC 6-1.1-7: Belween January 75 and March 2 of the year fhe deducfion isto�eBRect�NTY AUDITOR
See reverse side Ia additional instructions arrd qualifications. GIBSUIJ (;
,-, � , / n
Applifanl(ownefolmn r_seaieSGitfibl5 Iev stle) w..
number I legal
of real propely as of Mardi 1, arrent year
ofinlerest?
on record is differenl lhan Ihat ol applicanL irMicale below:
Name of morlgagae or canlracl seller
S-
Address of rtwrtgagee w mn1+aG seller (numberand s(reef, dty. state, arrtl LPCOde)
,
Name of asvgnee u Wher o.vner or holder of mortga�e
Address of assignee (rnmrbe� arM sheet, city, stete, aiM ZIP code)
Dces appliwnl own property in eny other
coumy in Induna7
❑Yes ❑No
Deduction apprwed in the amount of:
R����l//��4�
�d '000. �
unpaW as of March 1,
If owned with someone
Whai Ta<ina
oS- �%,�3� -
DrawerN�•......... � -
�LS.��......
CardN�• .. • f �
� —
Remrd number Page number
-� � S3 �'
Is lhe applicanl Uie sole legal or equitade ovrtie(?
❑ Yes ❑ No
�spouse,irMicalewilhwhom. '
Is the properry in question: _
❑ RPaI Property ❑ Mobile Harie (IC &1.1
-. � � �- �z 70�
H85 �115 dBd11dAM1 bCCll
for artent yeaR
zo
IICS� OII PfOpCIiY
❑ Yes ❑ No
zo
i tYAudilor T An/I� � I Date (rta/�.� yea�� D�
Q�! ' � U o�
I/ We certi under penalty of perjury tli t ih� _...e and foregoing infortrwtion is trve and mrteU and that the applicants was I were a resident of
Indiana and owner o e aforemenGOned operty on March 1, 20
�nalwe (,ow/ne/s (u/iname) Date (rtronih, day. yea�
17 bC�s ✓ ���.sa�S 11
�ie5id dtlress of applicant (num6er a sGeet. cily, sfafe, arttl ZIP mtle) �
� An� E C�r�:.., ,S�• ��� RrdNC� �1 • <'/7G�/B
Person
or bY IC 61.1-72-.07
of author¢etl petson (num6er arrdsVee{ cdy. stale, am1
day. yea�