HomeMy WebLinkAboutMortgage_Jordan.+"•�R STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
r,{,... _'� FOR DEDUCTION FROM ASSESSED VALUATION �
State Farm 43709 (RB / 2-07)
� Presmbed by Deparlment of Local Govemment Finarxe
1�
INS7RUCTIONS:
To be filed in person or by mail wil h fhe CountyAuditor o7 the county where the property is bcated. EP 1 q 20 0
Fding Dafes: 1J Real Property: Dudng the 12 months be%re June 11 0/ the year the deduc6on is fo be eflective. 4 Q
2) Mobrle Hames assessed under IC 6-1.7-7: Behveen January 15 and March 2 o/the year the deduc6�Jo be eBective ��
See reverse side for addifional instrucGOns and qualifications. GlR o., � V� �.�
conVac! biryer - see mstric[��s m raverse
:.7/V� I �(7—/(/�
value of real propeity as d March 1, curem y�r
t is his / Frer eaacl share of intercst?
If name m record is diRerent 11ian ihat of applicant, indiwte below:
Narne
( Reoord number Page number
�-a� y. -oa
I Contred iMebledness unpaid as of March i, Is Ihe appfipnl Ue sde legal w equitade o.me(.�
ar
❑ Yes ❑ No
If owned wilh someone dher ihan spouu. indicate wilh whom.
rtqrigagce m m�lr�eller (number (rM sfreet. dty. slate. and ZIP cWe)
��agnee a olher awner or holder of mortgage
Address of assiqriee (�wun6er aM sheef. dty. state. aM LP code)
Oces applicanl am property in arry other
counry in Indiana?
❑ Yes ❑ No
Dedudbn appmved in the amwnl oh
rl • �
yes,
24 � �
DisUict7
20
Is the praperty in queslian:
❑ Real Property ❑ Motzle Home (IC G7.1-7)
Has Nis dedudion been requesied on property
tw airtent yeaR
❑ Yes ❑ No
20 _ � 20
day,yea�
I/ We certi(y under the penalry of perjury ihat Ne above and foregoing infomiation is We and correct and Ihat the applicanfs was / were a resident of
Indiana and ownerof the aforementioned property on March 1, 20
j(�z$utq(6�y%e/s fidl neme) y� \ Da�e (nwnN, Oay, yea�
a( applicanl (nu � an street. city. slate.
� �i
duly exeated Power of Altomey or by IC E
persm (numberarW streel �+ty, sfafe. aMZiP mde)
i�
Date (monN, day. yea�