HomeMy WebLinkAboutMortgage_Brown (5);a`� �� STATEMENT OF MORTGAGE OR CONTRACT IIvDEBTEDNESS
1\i-' FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
\..«. "�+ StateFortn43709 (R6/5-06) � � � � ... .
� Presaibed by Department of Local Gmemment Finance
INSTRUCTIONS: File Mark
To be filed in person o� by mai! w8h the County Auditor o/ the county where the property is c e �{�
Filing Dates: i) Real Property: During lhe 12 monihs befoie ,lune �7 of the year fhe deduc 's�b e/fec�rP�'
2) Mobile Homes assessed unde� IC 6-1.1J: Between January 15 and Marc o/ �'on fo be eBective.
See �everse side foradditional instnictions and qualifications. DEC
4 2007
Applicant (owneror
Dislrict
- see res�ctions on reverse side)
Key number / legal description
Page
�
' b- -V - •VS •Ud.d
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 1, cunent year owneR ` ❑ Yes ❑ No �
If no, wha! is his / her exad share of interesl? If owned with someone'other.than spouse, indicate wilh whom.
If name on record is different than that of applicanl, indicate below: Is the property in question:
� _ ❑ Real Property ❑ Motite Hane pC 61.1-�
mortgagee or contrad seller
of mor�qagee ar conVact seller
of assignee or other owner or
Addreas of assignee
wmhkf andstieet, city, st�, ZIP
V
ar of mortgage
city, state, ZlPCOde)
Does applidnt own property in any other If y �/y ./-�7� Has this deduction been requested on
county in Indiana? � ,/,p�,�. .•i •��� property for wnent yea(.� � Yes ❑ No
Dra���er 1�0•
Deduction approved in the amounl of:
� ��
Signature
zo o �
P
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Card 1�0 . ..: ..............
- �P��` ���
m��%G3, �• ��
Zo _ , _., � zo
County Auditor
zo
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certify under the penalty of perjury lhat the above and foregoing information is true and corred and that the applicants was / were
�ent of Indiana and owner of the atorementioned property on March 1, 20
�ir (owners Iull name) Person authorized by duty executed Power of Attomey
�_�„ _ � � \� . _ or by IC 6-1.1-12-.07
of authorized person