HomeMy WebLinkAboutMortgage_Griffin (2).+�•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES:
�., 1 FOR DEDUCTION FROM ASSESSED VALUATION
Sta1e Form 43709 (R8 / 2-07)
�°�; �� Presaibed by Depahmenl of Local Govemment Finance
INSTRUCTIONS:
To be fi/ed in person or by mad w8h the CountyAudi[or of the county where the property is loceted.
Filing Dates: 1) Real Properfy: Dunng the 12 months befae June 11 0( fhe year the deductlon is to be e„o,.,a.,.---
2) Mobile Homes assessed under IC 6-1.1-7: Between Januery 15 and March 2 0/ fhe year the deduction is fo be effective.
See reverse side for additional insWctions and qualifications.
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whal
name
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Kay nylnber I lagal desaiption
-�d - / � -�c
as of March 1. aurenl year Mortgage /
� . 3� aR�„ �
/ her exacl share
Name of mortgagee or contract seller
- �!•.59./ -o
f indeWedness unoaid as M March 1.
Addrrss af mortgagce w mntrad seller (num6er arM Stree4 d1y. sfafe, aM ZIP co0e)
Name of assignee or o�her o.vner or holder of mortgage
Address M assgnee (number and sVeef. dty. stale, and Z/i
Does applicant own poperty in any other If y
cwnry in Indiana?
❑ Yes ❑ No
Deduction appmved in ihe amwnt of:
20�20 _ 20
r
Signature af Counry Autlitor
Is Ihe appGpnt Ihe sole legal n equifade oxnen
❑Yes ❑ No
wilh someorie dher Ihan spouse, indcate wi�h whom.
�he property in
❑ rn�ie H� nc �,.,
WhalTacingDisl G��r�� j'1�� .wperry
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�Ay c `� _
\UDROR O/� ^/� _
7— y
20 I 20
2�
I/ We certiy under lhe penalry oi perjury tliat the above and foregoing infortnafion is true and correcl and that the applicants was�/ were a resident of
Indiana and owner of ihe aforemention property on March 1, 20
signawre (owners n neme) � oate (mmth. day, yes�
i
r
residenl address o applicant numb d streei. cNy. state. aM ZIP code)
� G `� �� oti'
Person aulhorized by duy ezecuted Power of Ntomey or by IC 61.1-12-.07 Dete (mmN. day, yeen
Adtlress of auihor¢ed prlsan (numbe� arM sVeet aty. sfate, and Z!P wde)