HomeMy WebLinkAboutMortgage_KeithI,
.W.
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION qqqa6���cwn WW 7ppown��sqyip, Year
'a / Suta Fom: 43709 (RS / 4-03) , . ` � .. � . ' . , - ' � � .. � !7 � 1t--1 �i �!
,«. _ . . �. .�1..J �.�'�
P2scnDetl by Departmen� of Local Govemmeni Finance
� � �
INSTRUC710NS: File Mark
To be filed in person or by mail with the CountyAuditor o)the county where the property is locat�.' � �%�[ n
Filing Dates: 1) Real PropeRy: During fhe 12 months be%2 May 11 0/ the year the deduction is�to'6e'efreCtive:L�?�F�-�-��/,{. D
�- io�n�, r�i n��,. . i;,-. �^-'f
2J Mobile Homes assessed under IC 6-1 J-7: Between January 15 and March 2 0/ the`yearthe�deductionvs�to tie effective.
See reverse side for additional ins[ructions and quali�cations. ��
Marcp t
If no, wt
fl real
year
buyer-
number / legal description' - ` � Record number
/�--� �� - O��% �� -Q �j Page number �
r _
as of Mortgage / ContraU indebtedness unpaid as of � Is the applicant lhe sole legal or
March 1, current�/'r -��� � � owneR � Yes ❑ No
/ her exact share of interest�
If name on record is different ihan that of applicant, indicate be;ow:
1ame of mortgagee or contrad seiler
Address of mortgagee or contrea seller (number and street, city s
Name of assignee or other owner or holder of mortgage
Address of assignee (number�and street, city, �ta!e. ZIP code)
owned with someone other than spouse, indicate with whom.
Is the property in
� '-• ' •+:u
Does applicant own property in any other � If yes. what counly? !-"" ��r/�
wunty in Indiana? � p�
� ,• �6
�
Signature
approved in the amount of:
20 Q(�_
❑ MoGle Home (IC 61.1
been requested on
year7�] Yes� No
COUNNi �'��� ��� �/ ���
� 3ts, a �I- _
20 �Y � I 20 � 20
f _
Couniy Auditor
�
Date
20
' We certify under the penalty of perjury ihat the above and foregoing intormation is true and corred and that the applicants was / were
resident of Indiana and owner of the aforemertioned property on March 1, 20
FuII
Person authorized by duly executed Power of Attorney
or by IC 6-1.1-12-.07
of authorized person