HomeMy WebLinkAboutMortgage_Sirmans.s=—'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
r,, . � FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R8 / 2-07) y
•��� Rescnbed by Department of local Govemmenl Finance
INSTRUCTIONS: File Ma
To be filed in person or by mail with the County Auditor o7 the county where the property is located. � M g
Fding Dates: 7) Real PropeRy: Dunng lhe 72 months be%re June 11 o/tha yeai the deducGon is to be eAective. AR 1 2 CQ09
2J Mobile Homes assessed under IC 6-1.7 J: Behveen January 15 and March 2 0! the year the deduc6on is to be eAective.
See reverse side (w additional insWctions and qualifications. `}�� _._
Applican� wner w mnfraQ buyer - see 2sLicfims on re erse side) ,
Ta�d isUid - Keynumber/legaldesoiplion
' Q
Assessed ralue of re� property as d Mardi 1. curenl year Martgage / ConUa�
arrerrt year
, what is his I her �ad share of interest?
If name on recmd is different Ihan ihat of applicant, iMiote 6elar.
NameofmortgageeorcmUactseller - / / 1 _/�/�
C�
—� (/� �iv�/ � i
Adtlress of rtrorigagee w mnUaG sel le (num6er aiM sfreef, oty, sfate, aM ZlP
Name of assignee w oU�er avrrer w holder ot mortgege
Address of assignee (number eiM sLeef, city, stafe, and ZlP oode)
Does applicanl own poperty in any o�her If yes, whal county7
counry in Indiana?
❑ Yes ❑ No
— �� O
as ofMarch 1,
wmed wiih mmeone dher Ihan spouse, irWicate wi�h whom.
�
«
❑ No
Se propertyin quasUon:
Real Pruperty ❑ Mobile Home QC 61.1-7)
Drawer NO...a���....... —
� �v 7 -
CardNO . .....................
� 38, 9C0. � '"r
, _ �. ��� — No
COUNTYAUDROR
Deduction approved in lhe amount of:
20 O 20 20 _ 2b _ 20 20 20 _
P
SignaWre of CaunrylwtlROr Courrty Dale (manN, dey, yea�
I/ We certify under the penalry of perjury that Ne above and foregoing intortnation is W e and correct and Uial the applicant5 was / were a resident of
Indiana and owner of the aforemen6oned property on March 1, 20
1 Signa R(owne/s IWI neme Dffie (month. tlay. yea�
�0 �asident dtlress of a�nt (num6ei and sfieet. d(y. stale. aM LP wtle)
' /b' 20 5, 2�� S i�/�n ce �onl ii/ _ �o
Person au onzetl by duly exealed Po.ver of Allomey w by IC G7.1-12-.07 Date (mmN, day, yea�
Address of aulhoraed person (number arrd sfreel, cNy. state. arM ZIP oo0e)