HomeMy WebLinkAboutMortgage_Thompson (6)�,�
� �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`i' FOR DEDUCTION FROM ASSESSED VALUATION Count Tppp ship Year
'> ,�/ • State Fortn 43709 (R6 / 5-06) q � �}
� Presoibed by Department of Local Gwemment Finance F�J q b
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INSTRUCTIONS: File Ma�Z�OI
To be frled in person o� by mail with the County Audito� o/ the county where the property is located. �
Filing Dates: 7J Real PropeRy: During the 12 months before ,lune f 1 of the year the deduction is to be e�tf �ve. ¢�
2) Mobile Homes assessed under IC 6-1.7-7: Between January 15 and March 2 of the year ��9 '�dJEtlqp�i�;tR� n��8ective.
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See reverse side for additional instructions and qualifications.
Applicant (owner or ntrdct buyer- see restricfions on mverse side) •
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Taxing Distrid I(ey num er / legal description Record number /-� 7 - .
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'%"i.<1Z�/1�C,� alO -� �'I a- J�Od -00�, J� 08 � Page number ���
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is ihe applicant the sole legal or equitable
March t, curcent year March 7, current year owneR ❑ Yes ❑ No
��,00�v 35,000 .
If no, what is his / her exacl share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate betow: Is the property in question:
❑ Real Property ❑ Mobile Home pC 61.1-�
me of moRgagee or conVad seller � O Tn e���
.��3 TNomPso , ������
Address o� mortgagee or conirad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage (Jp�^ �� �
Address oi assignee (number and sUeet, ciry, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has this deduction been requested on
county in Indiana? propeAy for current yeaR� YesO No
COUNTY AUDITOR
Deduction approved in the amount of:
20 QZ 20 � 20 � 20 20 20 20
/
Signature County Auditor Date
' We certify under the penalty of perjury that the above and foregoing information is true and corred and that ihe applicants was / were
resideni of Indiana and owner of the aforemenlioned property on March 1, 20
S' nat � full name) Person authorized by duly executed Power of Attomey
� or by IC 6-1.1-12-.07
I resident ad ress of ap lipnt Address of authorized person
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