HomeMy WebLinkAboutMortgage_Hogmire,3 �%�
«.
�
STATEMENT OF MORTGAGE OR CONTRACT ItvDtBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
S�ate Fwm 43709 (R6 / 546) -
Presvibed by Department of Laal Gwemment Finance
INSTRUCTIONS:
To be filed in pe�son or by mail with !he Counly Auditor of the county where the property is
Filing Dates: 1J Real Property: Dunng the 12 months,befoie dune I1 0( the year the deduction is to be elfe�. 2 5 2007
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 2 o/the year t e deduclion is fo be elfective.
See �everse srde for additional instrsictions and qualifications. `�jj ,Qr��U"�,
__,.., .-�ti7Y AUDITOR
Applicant
Taxing District
Assess@d value'
AAarch t�wrrent
If no, what is his / her exad share of
If name on
see resmcnqqs on reverse
than that of
Key number / legal
Record number
) /_ ,r � �� _(,�^ � 7� Page number 1 I�
�� lQ 1 �fJ � 7
Morigage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owne(? ❑ Yes '0 No "
.�-�i�OZ�
If owned wilh someone other than sj� �
below:
❑ Real
moAgagee or contrad seller
Address of mortgagee or contract seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
of assignee (number and ��- ZIP code)
e �
: Cr1.1-�
�
/
_— ,
Does applipnt w�' �� ounty? What Taxing Distrid? Has this dedudion been requested on
county in '� �;� • �� property for current yeaf? � Yes� No
�,�a��eY �{�J . ..��•.
— �o
�a�
Ga
Deductic � �� �
20 O� 20�
Signature
�aay ,
,, of:
COUNTY AUDITOR
20 20 20
County Auditor
20
20
We certify under lhe penalty of perjury that the above and foregoing infortnation is true and corred and that the applicants was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
name)
1��, W 5bS S O�ve►,��1Ae_. �LPJ
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
of authorized person