HomeMy WebLinkAboutMortgage_Wise.��•n/ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
, FOR DEDUCTION FROM ASSESSED
S�ate Fwm 43709 (R8 / 2-07)
�•,_ � aoo�- c� y 9a
.,, � Presaibed Depanment of Local Govemmeni inance
File
INSTRUCTIONS: �
To be filed in person or by mail wdh the CountyAuditor o/ fhe county where the property is located. - �� �
Filing Dates: 7) Real Properiy: During the 72 months 6e(ore June 17 0/ the year the deduc6on is to be eflecUve. �
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and Maich 2 of the year the deduction is to be eNective.
See reverse si; fw additional instructions and qualifications. � � E C 2 y Z00$
Applrcanl I9�Y+kr w conVacY
D' UC
1. aarent year Martgage / (
artenlyear
�" , whal is his / her ev�aG share of interesl?
,l` • ,
If name on recmd is d'rfferent Ihan �hal of applicant, iMimte belav:
Name of morlgagee or conUaq seller �//�
!%( el /�
Adtlress of mortgagce a conNact seller (number arrd street, dty, sl
Name of assignee w dher oaner w hdder of mortgage
Address of assgriee (numbwarM sheet, dty, stafe, aM ZIP oode)
Does apdicant own property in any o�her If yes, whe
county in Indianal
❑Yes ❑ No
DeducUon approved in the amount af:
20 O9. ZO 20_
Q
SignaWre of CounryAudilnr
0
an0 ZIP roCe)
� Q�/
as of March 1,
owned wiih someone other lhan spouse, indicate wiU� whom.
a ey��aae o.men
❑Yes ❑ No
Is Ihe property in quesUOn:
❑ Real Property ❑ Mobile Home
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20 I 20
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❑ No
20 � 20 _
yea�
I/ We certfy under the penalry of perjury that Ne above and fwegoing infortnation is true and correc[ and that the applirants was I were a resident ot
Indiana and owner of the aforementioned property on March 1, 20 _
�
,
s�denl�tldress of applicant (number antl sheef. ci(y. s(afe, aM ZIP cotle)
�I �ib03 W 5�5 S, aWe.�iv,HC, � h�bb5
Person authorized by duy exewted Poa of Attomey a by IC 61. -12-.07
au�hor¢ed person (nbmbe/ aM streeL tdy. s(ffie.
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