HomeMy WebLinkAboutMortgage_Mason.� °�* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (RB / 2-07)
�1 j Presrnbed by Departmenl of Local Govemment Firence
�NSrnucnoNS:
To be filed in person or by mad with the CountyAvditor o/ the counfy where the p/operty is bcated.
Fding Dates: 1 J Real Property: Dunng the 12 months 6e(we June 17 ot fhe year fhe deduction is to be eAective.
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 75 and March 2 of fhe year the deduction is f��ef�ctive2008
See reverse side (or additional instructions arM qualifications.
Audican wner � mn7acY 6wer ss6�shictiocs m reverse side) 6"'�!
e �
Assessed value of real erty as af Mard
I�Hat is his / her exad share of inter
If reme m recartl is d'Aierent Ihan Ihat of
Name of mortgagee or contfaG seller
Address of rtartgagee m m�trafl seller (i
Name of assignce a dha awner or hdd
Address of assgnee (numbei arid sUeel,
Doe- applicant wm poperty in airy other
counry in Indiana)
❑ Yes ❑ No
1. artenl Y�� I MwtBa9e / ConUact
curtenl year �
i�mte below:
sfafe, eml ZIP code)
If yes, what
Detluction appioved in Ihe amoun� of:
20� 20� 20
SignaWre af Counly Auditor
'��as of March 1, Is Ihe
�t owned wM mmeone dher �han spouse.
number
sde legal w equitade oNne(
❑ Yes ❑ No
Is Ihe praperty in quesGm: �
❑ Real Prqo��� - -.r'' - -� � -
o___._. .
.O...afx��......
DI-a���cr
a��`I ,
c�ra�o� ... ..�..
��i�i��.
What Tarzing Dis4icl? vus detl�xlion bern requested on property
Ifw aurenl yeaf.�
a ❑ Yes ❑ No
20 I 20
20 _
Dale (monN. day, yea�
20
I! We certiy under the penalry of perjury that ihe above and twegoing infortna6on is Gue and correcl and tliat the applicanis was I were a resident of
Indiana and owner of the afwementimed property on March 1, 2b
� �sidenl address
c»y, stafe, arM ZlP mde)
executed Poaer oF Allwrrey a by IC
Atldress of auUur¢ed persan (num6er aM sGcreR dy. state, aM LP cotle)
o�a �mm�, aar. y��