HomeMy WebLinkAboutMortgage_Davis (3).�-�no STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Tow�ship Year
,x;� FOR DEDUCTION FROM ASSESSED VALUATION �"'�
S1ate Fartn 43709 (RS I 2-07) �� ��
�9 ° Presmbed by DepaRmeN of Local GovemmaG Finance
y�.
File Mark
wsrnucnoNS: AUG 1 5 2008
To 6e hled in person w by mad with the CowtyAuditor o7 the county where the properfy is brated.
Fd'mg Dates: 7) Real Property: During the 12 monfhs be%re June 77 0l the year the deduttion is fo be effeclive.
2) Mo6ile Homes assessed under IC 6-1.7-7: 8ehveen January 15 alM March 2 0/ the year the deductioY� �:Qo be e� � e.
See reverse side 7w addifronal insWctions arrd qualifications. d��� �j
Appica (amerorcpntrarlbuyer-seerestnctions eversesde)
GcJ � a-ttc � �' �Q�-�
�7au �isUicl . Key number I legal desoiption Reoord number
f�.-� �-oy-a3 -doo- poo -o� oo "1
Assessed rdue of real ryopaty as of March 1. amenl year Malgage 7 Contraci indeWeOness unpaid as of March 1. Is Ihe appGnnt Ihe sole legal
artrent year I � T
� what is his / her exacl share of interesl? ��t owned with someone dFier Ihan spouse, iMicale with whom.
�han Ihat oFapplican4 iiMipte below:
Name of rtrortgagee or conLaG seller //��
O .1�. /J .
Address of mortga9ee u conirad seller (number and sfreeC dty, stale. aiM
Name ot assignee or other aarrer or trolder of mortgage
Address of assgriee (numbel aM sfreet, city, s(afe. and Z/P code)
Dces applicant own property in any dher
counry in Indiana?
❑Yes ❑No
approved in Ihe amounl aC
����
If yes, what counly?
COUNIY
20 _
20
Caunry
Page mimber
x cquitaWe owne(1
❑Yes ❑ No
Is Ihe property in questirn:
❑ Real P�vperty ❑ Mobile Home (IC 61.
'`_ -
. .Y. ro'l r'� . . . . . . ..
pra���cr NO•
3301....� .
�;,1'(1 �o• ..•�150,�°.
�.�•� •
20
20
20
�
� No
I/ We certify under the penalty of perjury Ihal the above and foregoing informabon is we and mrrect and tliat the appfinnts was I were a resident o(
Ipdiana and owner of fhe aforementioned property on March 1, 20
adtlress of applicaM (num6er and street cdy. stafe, aM ZIP code)
N 7.7C:.�! .��:�)1�U L,i G�'?G
Permn aNhoraea by duN ��� Pawer of N�aney or by
persa� (num6erarMstreet,dty.sfate,arMLPmde)
Date (month, day yea�