HomeMy WebLinkAboutMortgage_Collins (4)°•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
� FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (RB / 2-07)
�' J Presrnbed by Departmen� ot Local Govemment Finance
INSTRUCTIONS: � d
To be filed in person or by mad wdh the CountyAuditor o! the county whera the pmpeAy is located. � �LJ
Fding Dates: 1 J Real Property: Dunng the 12 months befwe June 11 of the year Ihe deduction is to be etfec
2) Mobile Homes assessed under IC 61.7-7: Behveen January 15 end March 2 0l fhe year the deduc6ar is fo be e(fective.
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poperty as of Mamh 1, aarenl y�r MMgage I ConUacl indeblediress unpaid 3�{ Alarch 1. Is Ihe appfipnt Ihe sde legal or equitaMe awne(1
ai�rmlyear /� �/� C:V
❑ Yes � No
erzacl share ot inteiest? If owned wiTh someone dher Uan spouse, indicale with whom.
record is di(feren� ihan that d applicarrt, indimte below:
Name of nartgagee or caitracl seller
Adtl�ess ot mortgagee w mnVatl seller (num6
Name of assignee w oltre� o-xrier or hdder of r
Address of assignee (numbu and sLae( city, e
Dces appliCani own property in arry other �',
county in Indianal
❑Yes ❑ No
Deductbn appmved in the amount of:
zo oY p� i
I/ We certif(� under Ih¢ �enalry of perji
Indiana and owner of b�e aforementia
9ieef. dty, state. arrd ZIP
aod�- �3�5
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Is Ihe property in question:
❑ Real Property ❑ MotHle Home
zo
been requested on property
❑Yes ❑ No
zo
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the applicanis was ! were a resident of
Date (rtxnth, daY. Y��
Person autiror¢ed bY duy exewled Powcr of AllaneY a bY IC 61.7-12-.07 � ��e (/�^�. daY• Y��
Address oF aultoraed pe�sai (numbeiaM sVee4 �Y. sWte, arM ZIP code)