HomeMy WebLinkAboutMortgage_Algaier/` �� � STATEMENT OF MORTGAGE OR CONTRACT INDEE3't cD�IESS
�' = FOR DEDUCTION FROM ASSESSED VALUATION .. ou T ip Year
S- _ y Slate Form 43709 (R6 / 5-06)
� �«.
Presaibed by Department oi Lonl Gwemment Finance ._
�
INSTRUCTIONS: File Mark
To be �led in person or by mail with the County Auditor of the county where the property is locafed.�a� ,Qd
Filing Dates: 1) Real Property: Dunng the 12 months before ,lune 11 0( the year the deduction,!'�tg�ie e1f�t`tive. �
2) Mobile Homes assessed under IC 6-i. f-7: Between January 15 and March 2 8/YR'e }�drf���ddcilahT�to be eflective.
See reverse side for additional instructions and qualifications.
(owner or conntract buye� -
I, /iw � ll� �% ,l
Z��
Assessed value of real praperty as of
March 1, curcent year
restrictions on reverse
If no, what is his / her exact share af intere�l?
Key number / legal
i
Record number '
_ a o 0 l�
-/B-�Y-/�/-j�Od,OI(o -Od-.� Pagenumber � ? q
J (
MoRgage / CoMrad indebted
March 1, current year q q
/Oo c�oa ,
name on record is different than ihat of applicant, indicate b=1ow:
of mortgagee or conVaC seller
Address of mortgagee or conVact seiler (number and street, city,
Name af assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, sfate, ZIP code)
Dces applicant own property in any olher If yes, what county?
county in Indiana?
Deduction approced in the amount of:
20 ��
1
SignaWre
� •:
•
unpaid as of Is the applipnt the sole legal or equitable
owneR ❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
Vuhat
COUNTY AUDITOR
20 � 20 20
�
County Auditor
s lhe property in question:
❑ Real Prope�ty ❑ Mobile Hortre QC 61.
�ooG� �1.?
Drawcr NO...�-........9
�—
Card NO . ............:........ —
ed on
�� -�- � - --.._..,--...� ,..s❑No
20
20
We certiy under the penalty of perjury that lhe above and foregoing infortnation is true and correct and thal the applicants was / were
iesident of Indiana and owner of the aforementioned property on March 1, 20
exewted Power of Attomey
or by IC 6-1.1-12-.07
resident addr ss oi applicanl Address of autharized person
�'l67 (�v� `�Ir�2a-,r,� 76�P