HomeMy WebLinkAboutMortgage_Johnson (11)ry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi i
__ . FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fomt 43709 (R71 / 609)
�' ,.,. Fresaibea M �P��� � � Govenvnent Fu�ance
� e Mark
INSTRUCTIONS:
b be filed in person w by mail with Ure CounlyAuditw or Counry RecoNer ol Ne county where the property is located. F �
Fifng Dates: 1i Real PropeRy: Must fi!e tlunrn� the year for which fhe deducfion is soughL � Counry Auditor
2) Mobde / Manuladured Homes not assessed as Real Property: Must fiie dunng the twelve (12) months /��,�.
6e/ore March 31 oleach year the deduction is saght. � °^�7n�ef
See reverse side 7or addrtionaf instrtictbns and qualificafions. ._,,,�.� rn�
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popaty az W Mortqage / Contraa u
Marr3� 1, a�rmnt yeer
ena share of interest?
iRereM Nan ihaf al app9can; ud'xate Eebw.
: m m�traG seAer (n�mbrJ antl sbael �Y. smte.
othc awner w hoNer of mortgage
ticant own 7�7�Y in aM other
InEiana? ❑ Yes
oeauctlm, avw� � me amoum ae
No
If yes. what muni�7
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e53 UnpaiO az of Mw�qaqa
couNn auorroR
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Yes U No
�e ptoperty in Vuestim: AnnuaDY ASSeSSeE
Real RoPBKY Q Mmual�' A�s�Sed
. Mobile Fkrtx (IC 6
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20 20 20 _ 20 _ 20 20 _ 2(1 _
Sigfahue U Coimb Autlbor Caunry Date (rtnNh. daY• N�/)
I/ We ceNfy under Ne penalry of perjury Nat the above anC foregoing intormalion is We and correct and that Ne applicant is a resident ot IrWiana aM
owner I contract buyer ot the aforementioned property on date appliration is filed.
Si8^�nue (orneYS f� name) _ Date (rrm1A, tlaY. Yg�
F�ID r�siEen[ e0dress U app�rant (lZu�hDer
�oIS 5 Gi65a-, f
Person auuror¢eE M' dWY ezecuced Power
Pddr� af autha'ved person (number ern
�4 �'n}: state, aM LP ootle)
ncs�-on . Ta-, �f76�o
ciry, state, enALP mtle)
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