HomeMy WebLinkAboutMortgage_Birch (2).+, "—'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n 7 wnsh Year
;, .. � FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fortn 43709 (RB / 2-07)
�'';.,� � Prescnbed by Department of Local Govemment Finance
File a
INSTRUCTIONS:
To be filed in person or by mail wifh the CountyAuditor o/ the county where the property is loceted. � �Q ��
Fding Dates: 7) Real Property: Dunng the 12 months be/we June 11 0/ the year the deduc6on is to be eflective.
2) Mo6ile Nomes assessed under IC 6-7.7-7: Behveen January 75 end Marcb 2 07 Ure year the de�ugta r�hs tc �����YOR
See reverse side 1a addifional insWCtions arnd qualil'ications. '
Applicanl (qWhai ar qpntract buye. -
what is his I her e%acl share of intete517
Name
_ri �-7•u
�h9a9e / Contract
on recwd is different Ihan Ihat of applicant, indicate below:
seller
mortgagee w mntrad seller
sveeC ary, sare, aiaurcooe7
of assignee a mner o«�r w naaer m mortgage
asvgnee (number end sVeet city. sta(e. and ZIP code)
Dces applicanl own prvpeRy in any other
counry in Intliana?
❑Yes ❑ No
DeduCion apprwed in the amount of:
i
�
iv v —
as of Maroh 1,
y......�......
I . � a�z2� �.5i -�
Is the applirant Ihe wle legal w equilade owne(1
❑Yes ❑No
If awned with someone oUrer than spouse, iMitafe wi�h whom.
the MopaM in question:
�eal Property ❑ Mobile Home
Dratver nr0....°?Q7if
Card1�7�� ,...,��/�..... ..
Zp O Y I 2p _ I 20 _ I 20 I 20
Counry
20
sted on praperry
� Yes ❑ No
20 _
I I We certify under the penalry of perjury that the above and foregoing intortnabon is true and correct and that the applinnts was I were a resident of
Indiana and owner of ihe atoremertponed propeAy on March 7, 20
adtlress of appli,�ca7nt (number and street. tity. stale. aM Z�flP m�de)
� 5. `�GC�� Pr� /1.Ce-lZl� �n%
>rized by duty ezeate0 Power of NNmey a by IC 67.7-12-.07
ulhor¢edpelsm (num6eraMSVeeLaty.state.aMZlPOOde)
Date (month. daY. Y��)