HomeMy WebLinkAboutMortgage_Fortner (4)R�,
� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
'= FOR DEDUCTION FROM ASSESSED VALUATION
� � > State fwm 43709 (R6l 5-06)
Resaibed by Departmenl of Local Gwemment Finance
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INSTRUCTIONS: Mq�ile Mark
To be (led in person oi by mail with fhe CountyAuditor of the county where fhe property is located. 1 Q 2007
Filing Dates: 1) Real Property: Dunng the 12 months 6efore June 11 of fhe yea� the deduction is to 6e effective.
2) Mobile Homes assessed under IC 6-1. 7-7: Between January 15 and March 2 0/ the year the �ction i� tohe el(ective.
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See reverse side lor additional instruc6ons and qual�cations. ��BSON COUNTY q�0170R
Appli n(owne� o� cont2ct buyer - see iest�ictlons on reve�se sftle) .
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T ing District Key number / legal description Record number � O S
� d 6-/d - D 7- ioY- 000, o L�— Page number � Q� q
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Assessed value of real property as of Mortgage / ConVad indebtedness unpaid as of Is the applicant the sole legal or
March 1, current year March 1, curtent year ownef.� � Yes � No
5op0
no,
of interest?
name on
\�e of moRgagee qr w� ut
y'/
of mortgagee or contract
Name oi assignee or other owner or
Address of assignee (numbe� and s��
Does applicant own property in any <
wunty in Indiana?
20 �
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Signature _
1 I We ceRi
(numberand
If yes, what
If owned with someone other than spouse, indicate with whom.
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city, state, ZIP
� Real
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question:
� Mobde Home pC 61.1-7)
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What T:
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COUNTY AUDITOR
in the amount of:
20�_ 20 o q 20 20
1 J
County Auditor
20
:sted on
!y� " f ."es❑ No
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under the penalty of perjury that the above and foregoing infortnation is true and correct and that the applicants was / were
Indiana and owner of the aforementioned property on March 1, 20
e�{ �ne/s full r
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dent address of
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Person authorized by duly executed Power oi Attomey
orby IC 6-1J-]2-.07
Address of authorized person