HomeMy WebLinkAboutMortgage_Bennett (6)ii k STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
'�i' ' FOR DEDUCTION FROM ASSESSED VALUATION � ! T hi Year
«. / State Form 43709 (R6 / 5-06)
`� Resrnbed by Departmenl of Loml Gwemment Finance
�
INSTRUCTIONS: � � F;�e�i �
To be filed in person or 6y mail with the CountyAuditor of the county whe�e the prpperty is I ated. ��
Filing Dates: 1J Real Property: Dunng fhe 12 months befo2 ,lune I1 0/ the year the de uction ' fo b B£dB�C UNTY AUDITOR
2) Mobile Homes assessed under lC 6-1.1-7: Between January 15 a�ch �e deduc6on is to be effective.
See reverse side for additional instrocli ns and q�l�lifrc�'o� �_ � � n J
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buyer - see restp�tions oq reverse
Key number / legal description
- - "G- � - U ,11�U-O
Assessed value of real property as of . MoAgage / Contrad indebledness
March 1, wrrent year March 1, cunent year
�1.J
If no, what is his / her exact share of interesl? f If o ned witl
If name on record is different than ihat of applicant, indicate below: '
of mortgagee or contrad seiler
Address of mortgagee or contrad seller �
r
f�
and st2et,
assignee or other owner or holder of mortgage
Addresa of assignee (number and st2et, city, state, ZIP code)
Dces applipnt own property in any other If yes, what county?
county in Indiana?
Deduction approved in the amount of:
20 0�
Signature
� aigr
Full
� l.
20 �
r
Record number /
U
Page number /�/�
a
as of Is the applicant the sole legal or equitable
owner? ❑ Yes ❑ No
someone other than spouse; indicate wilh whom.
,.�b�-s
propertyin question:
�❑ Real Propsty ❑ Mobile Home QC 61.
� �9 !� O$—S�i�6
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state, ZIP �' `
a�y
Pr
_ ������ ��� ��?� � \
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Taxu._
COUNTY AUDITOR
20 20 20
County Auditor
20
Date
aen requested on
, �year?�Yes�No
�
certify under the penalty of perjury lhat the above and foregoing information is true and corred and ihat the applicants was / were
lent of Indiana and owner of the aforementioned property on March 1, 20
appli nt
Person authorized by duly ezecuted Power of Attomey
or by IC 6-1.1-12-.07
authorized person
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