HomeMy WebLinkAboutMortgage_Grubb"' �" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count 7ownship Year
- :� FOR DEDUCTION FROM ASSESSED VALUATION
� • �� StateForm43709(R411P01) - " �� 1 � � `,--� G -r
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Pcesaibe0 Dy Deoartment o1 Locai Govemment Finance � .y-( �
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INSTRUCTIONS: D E C �' 4 Fi�j �ark
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To 6e �led in person or by mail with the County Audilor o( the county where the property is located. .
Filing Dates: f) Real PropeAy: During the 72 monfhs belore May 17 of the year the deduction is fo be eflective. �
2) Mobile Homes assessed underlC 6-1.1-7: Between January 15 and March 3/� the,year �e�ed�l�o b,e'effective.
See reverse side (or additional instructions and quali�ca(ions.
- G!BSO� 1 Cnll�! � Y nUUIT04 �f
Applicanl (owner or contract buyer- see resMctions on reverse slde)
e ` U/ � Pu e �t
Taxing Distrid Key number / legal e
� �lo�t 6�ne� 005-039."
Assessed value of real property as of Mortgage I Contract ir
March 1, current year March 1, current year
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If no, what is his / her exact share of interest?
If name on record is different than that of applicanl, indicate below:
'Q�
:dness unpaid as
Record number
�D3-��fd�
Page number
f Is the applicant�t,h,e� le legal or equitab
owner? Ly'1'es ❑ No
n, � � �
If owned with someone other than spouse, indicate with whom.
�me of mortgagee or contraU selier
�,-�e� �-a 8�?� N, �1,
Address of rtgagee or contrad seller (number and stieet, crty, state, ZIP
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Name of assignee or other own r or holder of mortgage
Address of assignee (number and st2et,
Does applipnt own property in any
counry in tndiana?
Deduction approved in the amount of:
state, ZIP code)
s the property in quesnan:
❑ Real Property ❑ Mobile Home (IC G1.1-
O7
If yes, what county? What Taxing District? Has this deduction been requested on
property for current year?❑ Yes❑ Nc
COUNTY AUDITOR
20 D I 20 � I 20 � I 20 FJl/
�r'�� � I �
iinnatura COUf11y Alldltof
20 �� I 20
Date
20
I/ We certify under the penalty of perjury that the above and foregoing informalion is true and correct and that the applipnts was / were
a resident of Indiana and owner of the aforementioned property on March 1, 20
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of applicant
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Person authorrzetl by auly execmeo rowe� ui nuu���cy
or by IC 6-1.1-12-.07 '
of authorized person