HomeMy WebLinkAboutMortgage_Johnson (4).a °"� STAIEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS t Year
FOR DEDUCTION FROM ASSESSED VALUATION
S1ate Fortn 43709 (R8 / 2-07)
S ` 1 pr¢sp�bed by DepaNnenl of Loral Govemmenl Firence -
uw
` File
INSTRUCTIONS:
To be filed in person or by mail wrfh the CountyAuditor of the county where the pmperty is located. `'-3 .�� ��
Fdin9 Oates: 7) Real PropeAy: Dunng lbe 72 months belore June 17 of the year t6e deduction is to be etFective. l��
2) Mobrie Homes assessed under IC 6-7.7-7: Behveen January 15 and Marcfi 2 o/the year the ded�����v�
See reverse side lor additional ins6ucGons artd qualifications. AUDITOR
Appiicam (aq*�er or wnfrap 6uye� - see restQe�ons an revyrse si{}e) /
1
charn nf infarxl�
If reme on recurd is dd(erent Ihan Ihal of applican4 irWiple belavr.
Name of nqrtgagee or canUaU
Address
mimber
_ V �' Q —
7e I ConVad indebtedness unptid as of March 1, is Ihe app6pnt ihe sde legal or equila e r
year �
��Yes ❑ No
If wrtied wiih someane other Ihan spouse. indicate with whom.
shee(. dty. state. arM ZIP oode)
Name af assignee w dhei awner w holder af mortgage
Address of assgnee (numbeiarM sVeet, city, sfafe, arM Zll
Does applicant awn prapeM1y in arry other If y
courLLy in Inda�?
❑ Yes � No
Deduction approved in the amount of:
2p� 20 � 20
P P
Si9�Wre of CounryAUdAOr
whatcounry7
couNrvc
Is �h�e prqoperty in quesUOn:
❑ �rroperty ❑ Mobile Hwne QC G7.
D�-a�rcr NO..6.�'.`.2 3.9-3
Card NO. —�
.....................
20 I 20
�
20
'.ed on property
Yes ❑ No
20 _
I/ We certify under Ihe penalty of perjury ihat Ne above and foregoing information is true and mrrect and that tlie applipnls was / were a resident of
Indiana and ovmer of fhe atorementioned property on March 1, 20
viaMre7owne/slull name 'i . Dale (nqnN, tlay, yea�
Person aulhoraed
or by IC 61.Y72-.07
l�{� � �
Address of aulhor¢ed pr�son (numbeiarrd sGeet dty. state, and LP oode) -� "
day, yea�