HomeMy WebLinkAboutMortgage_Dillard.P"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
a:".. '
FOR DEDUCTION FROM ASSESSED VALUATION
- Slate Form 43709 (RB / 2-07)
S a� 1 Prescnbed by Departmenl d Local Govemment finance
File Mark
INSTRUCTIONS:
To be filed in person or 6y mad wdh the CountyAuditor o/ the county where the property is bcated. � U L �� Z ��l i�
Fdinq Dates: 1) Real Property: Dunng the 72 monMs belore June 11 of the year the deducGon is to be ef/ec6ve.
2J Mobile Homes assessed under IC 64.1-7: Behveen January 15 and Marth 2 of the year the deducBon isto� (�� 6y�. �
See 2verse side !a additional instructions a� qualificafions. � Fa��
Applicant (owner�pi n. n n����� JLl'n)1 /�V .
DisGicl
� �(o`l l'1 d' JUI'
ralue of real popsty as of March 1, aarent yrdr
of inte2sl?
name m recwd is diRerent �han U�at of applican4 ��icate below:
Name of mortgagee or conllaU seller
� v Remrd number Page number
.o _ a8 �
�e / ConVad indebledriess unpaid as of Match 1, Is �he appGcant Ihe sde legal a equilaWe wmeR
Y��
❑ Yes ❑ No
IF owned wilh someone dher ihan spouu, i�rate wifh whom.
Adtlress of mortgagee w mnirad selier (n�mbuand street, dty, state, and LPcrode)
Name of assignee a dher ow�r w hdder af mwigage
Address of asvgnee (ruxn6u arrd streef. city. sfate, and
Daes applicard own propeM1y in arry dher
courrty in In6ana7
❑ Yes ❑ No
apprwed in Ue amount of:
+ I -��
Is Ihe property in question:
O Real Property ❑ Mobile Hare (IC Gi.
V vi<�
���� �
�OOG - �US�
20 I 20
Caunry
s Ihis dedu�ia, been.equested un p�erty
a,R�,� �n
❑ Yes ❑ No
20 _ 20
Date (ma�th. Oay, yea�
I! We certify under the penalry of perjury iha[ the above and foregoing infortnation is true and correct and that ihe applinnts was I were a resident of
Indiana and owner of the aforementioned property on March 1, 20 _
auUwra� 6y duty ezea��ed
and streeL cM. sfate,
or by IC E1.1-12-.07
auUwr¢ed persan (num6er aM stree(, aty. state, and LP mde)
Dale (rrimfh. day,
Date (monfh. day, yea�