HomeMy WebLinkAboutMortgage_Utley (3)��•* STATEMENT eF MORTGAGE SR C4NTRACT INDEBTEDNESS
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= FOR DEDUCTION FROM ASSESSED VALUATISN
S�ate Form 43709 (RB f 207)
�O ;e„ � Resaibed by Departmenl of Local Govemment Finance
Coun Township Year
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INSTRUCTIONS:
To be filed in person or by mail wdh fhe CountyAuditor o/ the counfy where the property is located. - �A N s
Fding Dates: 7) Real Property: Dunng the 12 months before June 11 o/the yearthe deduclion is to be eflec6ve.
2) Mobile Homes assessed under IC 64J-7: Behveen January 75 and Maich 2 0/ the year the deducSon is to ba et/ective.
See reverse side /a addifional instructions and quali�cafions.
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Appiicam
Ta� isUicl '�� _' I,e� m-r/legal
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Assessed walue of real property as of March 1, aurent year
ezad
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Name of rrrortgagee orconUacl saller
'VD l• UG`j`Oo� b
Mw�gage / ConUaC indeWedriess unpaid as af March 1,
artenl vea� � .
AdLress ot mortgagee w mntract saller (number eM shaeL dty, sfafe.
Name of assignee at dhei o.vner or hdtler of mortgaga
aperty in arry othar
❑Yes � No
Deduction appmvetl in lhe amount
20 ZO_
Signawre of Counry Audiinr
wmeone
2009
Is ihe applinnl ihe sde legal w equitade ame�
❑Yes ❑ Na
spouse, indicate wiih whom.
Is ihe property in queslion:
❑ Real Property ❑ Mobile Home pC &1.1-7)
Z,P�.., �� R�Sg ,�
I� tE �
I �/1 � � Hes this de
� �� iforwnent�
- 08 �
F__ I 20 _ 20 _ 20
,iesletl on property
❑Yes ❑ No
Dale (mmfh, tlay, yeeA
20
1/ We certify under ihe penalry of perjury that the above and foregoing intortnaGOn is trve and mrtect and tlial the appficant5 was I vrere a resident of
Indiana and owner of the aforementioned property m March 1, 20
inawre (ownals fiAI neme) . _ Date (monN. CeY• Y��
cdy. sfate. and ZIP cvde)
Power af Altwney or by IC 61.1
of alAhor¢ed peraon (number aM strBef,
Date (mmM. tlaY• Y��