HomeMy WebLinkAboutMortgage_Rogers (5)��` rtp�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`i' : FOR DEDUCTION FROM,ASSESSED VALUATION o n wn h Year
'�. ._ J State Fam 43709 (R6l 5-06) .. .
Presaibed by Department of Local Govemment Finance Q E 2 S 2007
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INSTRUCTIONS: �v#��
To be filed in person o� by mail with the County Auditor of the counfy whe�e lhe property is locafed. GIBSO� UU�T � ITOR
Filing Dates: 1) Real Property: Dunng the 12 months be%re June 17 of the year the deduction is to be eflective.
2) Mobile Homes assessed under IC 6-1.1-7� Between January 15 and March 2 of the year the deduction is to be eBective.
See �everse side for additional instnictions and qualrfications.
or crontinact buyer - see
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Assessed value of real properly as of
March 1, wrrent year
If no, what is his / her exact share of interest?
on reyerse side)
Key number / legal description Record number
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/� 7 Q a 8 Page number ' g CJ J7
Mortgage / Contrad indebtedness unpaid as of Is the applicant the,sole legal or equitable
March 1, currenl year ownef? ❑ Yes �'No " "
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If owned with someone other lhan spouse, indicate with whom.
name on record is different than that of applicant, indicate below:
�e of mortgagee or contract seller
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Address of mortgagee or conVad seller (number and street, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and stieet, city, state, ZIP code)
Does applicant own property in any
county in Indiana?
approved in the amount of:
If yes, what county?
20 � 20 O`� I 20
P P
What Tauing Distrid?
s the property in question:
❑ Real PropeAy ❑ Mobile Home pC 61.
Has lhis dedudion been requested on
--�-�- `-- _•--'........n 1=l_ves❑ NO
I - 'Dra��=er NO.'.rh�!l1.7..:.70�
couNrv aui . .
.� . - ��_ �
�g Card NO. . . �
/jI� o'jS 0.00 �y6d.4l,��0 �t••
20 � 20 � 20 _ _ I 20
County Auditor
Date
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certify under lhe penalty of peryury that the above and foregoing infortnation is true and corred and that the applicants was / were
ent of Indiana and owner of the aforementioned property on March 1, 20
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
ruu reswen� aaaress or�eppucant Address of authorized person
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