HomeMy WebLinkAboutMortgage_Ice (3).��•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
r,.. FOR DEDUCTION FROM ASSESSED VALUATION
_• State Fartn 43709 (R8l 2-07)
�s�;: '� Resaibed by Depanmenl of Local Govemmenl Finance
INSTRUCTIONS: 1 File M2rk
To be �led in person or by mail with the CountyAUditor o! the county where fhe property is lorated. � MAR 1 8 2��9
Fding Dates: 7) Real Property: Dunng the 12 months be/we June 77 of the year the deduction is to be eflecfive.
2) Mobile Homes assessed under IQC 6-7J-7: Behveen January 15 and Maich 2 of the year the deductlp�s to�b'el eN�cJiys.
See reverse side /w additional instructions arrcl ualificafions. � rC3 /fs�
anl (ownrypr mnVact buye� - see 2 � fims re
J
OisUid Keynumber/Ir�;a
- e - 3`�
sed ralue of real propaly as d March 7.... ;mr
whal is his / het exact share of interest?
sitle)
If name on record is dAterenl ihan Ihat of applicant, intliote below:
Name of morigagee or contrxt seller A • _v 1^1- _ _'
�J{.I�/►�� v�
Address of mortgagee n wntraa seller (number aM street. dty, state. eM ZIP cotle)
af assigrree w other owrrer or hdder of morigage
Address of asvgnee (numbeiaiM sLeet, crty, stafe. and ZIP oode)
Does applicanl own property in any dher If yes,
tounry in Indiana? '
❑Yes ❑ No
Deduction apprwed in Ne amaunl of:
�� �_ za_
SigraWreo� nh�tlitor
� �D�
lness unpaiC as of March 1,
If rnmed with wrtreane
�Yv
V^
q
�-������7 i
�
'•' - - OV.J�J � .
Di-a�ver \O..'..3� l .......
Cal•(� \� . .................�..
# I(�5,'i�. �
Caunry
Rewrd
spouse,
w equitaGe amer
❑Yes ❑ No
Is ihe property in question:
❑ Real PtopeAy ❑ Moble Home QC 61.1-7)
KY
Q_n 'O
ir��i
.S�" `s `-\J _
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- �, 3
I/ We certiy under lhe penalry of perjury lhat the above and foregoing infortnation is We and mrred and that tl
tndiana and owner of the aforemenCOned property on March 7, 20
(number and sGeef. cdy. state. a� ZIP
w
Addrass of aulhor¢etl person (number arM sbeet dty. s(ate, aM ZIP wde)
Date (monN, tlay, yea�