HomeMy WebLinkAboutMortgage_Osborn°"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Tovmship Year
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (RB / 2-07)
�� '..� 1 PresmDed by Department of Laal Govemment Finance � i\�
V\ File MaAc
INSTRUCTIONS:
To 6e filed m person or by mail with Ne CountyAuditor of the tounty where fhe property is located.
Fdmg Dates: 1) Real Property Dunng the 72 months before June 17 d the year the deduction is to be etiective.
2) Mobile Homes assessed under IC 61.1-7: Behveen January 15 and March 2 0! the year the deduc6on is to be eAective.
See reverse side /a addifional instructions and qualifications.
lwdicam (owner or wn[pd dygr - see rp�Yric6ms 9Lr reverZe side)
Tariig Oistricl Key number / legal dc
ab t�- 3b -
Asessed ralue of 2al property as of Mard� 1. artenl yrar I
If ro, what is his / her eza�%share ot in�
i� m recortl is dAlerenl �han ihal t
Name of mortgagee or conlrxl seller
Address of mortgagee or conUaW sdler
Name of asvgnee a dher owner a hol
Address of asvgnee (rueMe` a�M sfree
DeduUion
�
Sigreture
- l. 4 /' oc
I ConUact indebtedriess unpaid as of March 7. Is Ne a�
:ar r.
I( wmed wilh someane a9her Ihan spouse,
applicant, indimte 6elow: •
num6erarM3reef. o fe. arrdZlP fode)
m of mpigage
tity, �ale. and ZlP wde)
own poparty in any other If
a�
❑Yes ❑ No
wed in the amount of:
_ p�_
Dra�ve►•\'0..��.-../ �,�/�
Card i\�O, ��`
.....................
Counry
❑ Yes ❑ No
Ne property in question:
I R�I Property ❑ Mobile Home (IC 61.
es lhis detludion been reques�ed on proper�y
r arrenl yeaR
❑ Yes ❑ No
20
(man(A, Cay. yea�
20
1/ We ceNfy under Ihe penalty of perjury ihat the above and foregoinq infom�ation is We antl correct and that the applirants was I were a resident of
Indiana and owner of fhe afwementioned OroP�Y � March 1, 20
plicanl (number and sGe t cdy. sfate, and LP mde)
��t� o� �GJ�'n1SJ1��6�
�ea,ied aw�e� �ra�,ey «ny ic �i.i-�z-.o��
of aulhor¢ed pasai (number erM shee4
Date (manlh. day, yea�