HomeMy WebLinkAboutMortgage_Collins (3).��* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
,, .,. � FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (RB / 2-07)
���;- � Presaibed by Departmenl of Local Govemmenl Finance
INSTRUCTIONS:
�'I�...,�"
To 6e filed in person or by mail wdh the County Auditor o/ fhe county where the property is bceted.
Fding Dates: i) Real Property: During the 72 months belore June 17 0/ the year the deduction is to be eflec �
2J Mobile Homes assessed under IC 61. 7-7: Befween January 15 and March 2 of the year the deducfion is to be eRec6ve.
See reverse side !a addi6onal insWC6ons and quali(cations. MAR 1 6 ZQO9
Applicanl (owner or mnUaC b i- see resfir�ions re rse srde)
7abng �strid Key number / leg desaiplion
I ` - -0 - �f -
Pssessed ralue of real properly as d March 1. aarent year Mortgage I
airtent yes
, whal is his / ner eaact sl�are oi interest?
If name on recwd is diffxen� Ihan Ihal of applicant, intliote Eelow:
Name of mortgagee orcantracl seller
rtqrtgagae w mnUaG seller (num6ei aM sheet.
signee w olher owner w Mtler of matpapa
Atldress of assgnee (nwnF--
Does aDW�m own propen
county in Indiana?
❑Y
Deduction approved in lhe a�
��
���,� �,�v� r�
��
O� - �� �
20_ � 20_
�
as of March 7
If owned wiTh someone dher than spouu, indicale wi�h whom.
!OR
_ 20
Cwnry
❑Yes ❑No
Is ihe property in Question:
❑ Real Propertv ❑ Mobile Home OC 61.
requested on ryoparly
❑Yes ❑ No
20
Date (monfh, Cay,
20
I/ We certify under [he penalty of perjury Uial the above and foregoing information is true and cortect and that the applicanis was / were e resident of
Indiana and owner of the atore entioned property rn March 1, 20
�aWre (owne/s hdl nartre) � . � � Date (ma�th. dey, year)
sfrael. cdy. stefe. arM ZIP wde)
Person authorized by duty execuled Power of Atinmey or by
person (numberaMstreal,city.state,aMZlPootle)
6 foS
o� ��m, oer. r��f