HomeMy WebLinkAboutMortgage_Rexinga°•* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709 (RS / 2-07)
�1 ,•�. r F'resmbed by DeparUnenl d Loral Govemment Finance
INSTRUCTIONS: /�
To be filed in person or by mad with the CounfyAuditoi of the county where fhe property is located. �1� -.N, p1jO�
Fding Dates: 7) Real Property: Dunng fhe 72 months 6efare June 11 07 fhe year the deduction is to be elfective. �� V yTY pU
2) Mobile Homes assessed under IC 6-7.1-7: Behveen January 15 and Maich 2 0/ the year the deduction G1tBo��gl�e.
See 2verse side (or additional inshucGons arrcl quali�cations.
AppliraM {nwpqi n confrarl6�qer - M reverse sde)
of leal propaly as o( Mart3� 1,
1�1a1 is his / her ezad
If name m recwd is dillerer
contracl seller
indipte below:
-,U
eP�/Cor
SarO
Address oi mortgagee or mntraa seller (number arM sVeeG dty, sfate. arrd ZIP co0e)
Name of assi9nee w other o.vrier or hold
Address of assignea (mxn6el erM stree;
Daes applicant wm property in eny oiher
county in Indiana7
❑ Yes ❑ No
Deduction appmved in the amwnt of:
20 2b _
SignaW re af Counly Aud'GOi
sfate, aM ZIP oode)
If yas, whal
L
s''�i0-0�
unpaid as of MarCh 1,
someone
Remrd number
Is �he appGpnt Ihe sole li
spouse. indirate wi�h who
a equitahie owneR
+MYes ❑ No
Is �he Property in quesGon:
�al Property ❑ Mobile Home
�'l�I- �90�� _ - -
Whal T�ing Di; �V��' _ �_ " �. ��.�i�%1
v f(
1UDITOR ��++�nl �. Jp{iC �/ J(J��. J O ,
i
20 _ I 20 _ I 20 I 20
Date (manth. day, yea�
20
I/ We certify under the penalty of pe�ury that the above and foregoing infortnation is We and correct and that tlie applicants was I were a residenl of
Indiana and owner oi Uie aforementirned property on March 1, 2(1
Tai�r�o�ers rw� � � / •
Date (monlh, day, yea�
tity. state, and ZIP oode)
Power of AttpneY or by IC Cr1.1-1
person (num6ei arrd s6ee4 �Y. state, a� ZIP mde)
Y�A