HomeMy WebLinkAboutMortgage_Witzel'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townsh
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709 (R8l 2-07)
�,�w' 1 Presmbed by Depar�ment of Local Govemment Firiance
� �e�
�NSrnucnoNS:
To 6e fiied in person or by maB with the CountyAudito� of the county where the property is located.
F7'v�g Dates: 1) Real Proper(y.' During the 12 months befwe June 11 d the year fhe deduction is to 6e eflective.
2) Mobile Homes assessed under IC G1.7-7: 8ehveen January 15 and Maich 2 of the year the deduc6on is to be eA�{j�
See 2verse side fa additional ins6uctions and quali(cations. � � R 9
Applirard ( r Y'_ 6uyer -See re4.c[�s m ryversq sde� w w(� `�777
1! 1 I 11 O'[a','
Taidng �isUiG
ralue of real ptoperty as af MaN� 1, arrent year
t is ha / her ezacl share of interesl?
on reard is diflereni Ihan thal of appiicar� indimte below.
Name of mortqagee ar canVaG seller
Address of martgagee or oonUa�i seller (numbrs and alreel, dty.
or hdder of moricjage
A� :gnee (number aM sfieet dty. sfafe. arW Z!F
Does applicant wm property in any olher
�,�Ty � i�a��?
❑Yes ❑ No
aPPrwed in Ihe amwn� of:
� l) b I p
Ye�
�
�UtJI • l { V' f )d�
:/ ConUad indeWedrress u�as of March 1
.arn �i �
..',
If omied wdh someone o
Is Ihe
spouse, i�cafe with whom.
��i
Q
❑Yes ❑ No
Is Ihe praperty in quesUon:
❑ Real Property ❑ Mot„Ie Home QC 61.
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DrawerN�' • ;.• •' ;��d�
.urtem
Card ��' '-
..••••�CbG��0�.00 —
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� � �Y
�'� ��9�,� -
i
20 _ I 20 _ I 20
�esiea o� w�ny
❑ Yes ❑ No
Date (monN. day, yea�
20
I/ We certify under Ihe penalty of perjury that the above and foregoing infom�ation is we and mrtect and that tlie applinnts was / were a resident of
Indiana and owner of ihe afwemenUOned property on March 1, 20
�aa . �w�p � n Date (mmth. daY• Y��
d i add ess of apWicant (numGw�(d sLee1. city. state, arM ZIP code)
�S� E STATE ST�. Q'�h+Gt�D"
autha¢etl by duy ezeaited Power oflLLtaney w by IC 61.1-12-.07
AEdress of author¢ed persan (num6ei aM s4eet aty. sfate. arW LP rode)