HomeMy WebLinkAboutMortgage_Tanneri i V� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`i•�; FOR DEDUCTION FROM ASSESSED VALUATION Count Townshi Year
`: � S�ate Portn 43709 (R6 / S-06)
� M Presaibed by Oepartmenl of Loral Gwemment Finance
JUN 2 5 2007
INSTRUCTIONS: File Mark
To be liled in pe�son or by mail with the County Auditor ol the county where the propeRv is located. �
Filing Dates: 1) Real Property: Dunng the 12 months be%re ,lune Il of the year the deduction is to be e(fe i
2) Mobile Homes assessed under IC 6-7.7-7: Between January 15 and March 2 of fhe ����R �a10ID�ective.
See reverse side for additiona/ instnictions and qualifrcations.
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Applicant rorcontractbuyer-seere n
������ �,
Taxing Dislrid
L
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Assessed value ofrealproperty as of
March 1, wrrent year
If no, what is his / her exad share of interest?
Key number / legal
March 1, current year
Ii
If name on record is different than lhat of applicant, indicate below:
��me of mortgagee or contrad seller /J
( � ( / //L
Address of moAgagee or contrad seller (number and street, a, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (numberand s6eet, city, sfate, ZIP code)
Does applicant own property in any
county in Indiana?
Deduction appro��ed in the amount of:
20 �_ 20
P
Signature
�
If yes, what wunty?
Record number
Page number //a�
� ��
as of Is the applicant the sole legal or equitable
ownef? ❑ Yes ❑ No
with someone other lhan spouse, indicate with whom.
Is the property in questian:
❑ Real Property ❑ Mobile Home QC 61.1-
` DC�\VCC NO..4���........ ^- _—
— c�Ca �io. ... y.�!.5........
—' �c�.nA1ti.� � � a8, �• �/
Wh; _...:�� �equested on
� property for wrrent year? � Yes ❑ No
COUNTY AUDITOR
20 20 20
County Auditor
20
Date
20
certify under the penalty of perjury that the above and foregoing infortnation is true and corred and lhat ihe applicants was / were
I�nt of Ind"�at�a�owner of the aforementioned property on March 1, 20
f�
applicanl
i�
executed Power of Attomey
or by IC 6-1.1-12-.07
4ddress of authorized person