Mortgage_Brewer1
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.p °'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
_ _ = FOR DEDUCTION FROM ASSESSED VALUATION � � � �
- State Fam 43709 (RB / 2-07)
�' `�� Presrnbetl by DeOarlment of Local Govemment Finance
ww
wsrnucnoNS:
AUGMa� 2008
To be filed in person or by mad wdh the CountyAuditor o7 fhe county where the property is bcated.
Fding Dates: 1) Real Property: Dunng the 72 months be/ore June 77 W fhe year tlre deduction is fo be efiecfive. /� ,/
2J Mobile Homes assessed under IC 6-1J-7: Befween January 75 and March 2 0l the year fhe deduc6on is to be e�iX� �v ra��,
See reverse side fw additional ins6vctions and qualifications. [/ ��
r.iaSON COUNTY AUDITOR
qssgsed value of real papeM1y as
-see re
� �
Key number / lega
a� -� -,
d March 7, aimM yrar
share of inleresl?
m recwd is dfFerent Ihan Utat of
Name of
Address of moAgagce w conUacl
sioe)
�P�� Rem�d number Page rwmber
�-ioo-000. �o�-Da7 0 3993
�+�ease � comraa u,d�ed�s �naad as ar n�tin i. is u�e auvemm u» sde ie� a. e��ade �n
artent year
[ S,j �O ❑Yes ❑ No
If o.med wiU� someone olher ihan spouse. irWifate vnih whom.
�✓1/ '� � .
nd sfree(. dty. sfafe. and ZfP code)
or oUrer owner or halder of morlgage
Address of as9g�e (num6er and sLeet.
Does applicanl own property in any o�hu
county in Inda�7
❑Yes ❑No
Deduction approved in ihe amounl of:
�
SignaWre of Caunrylwdiior
�
Ifyes,whatcount)? WhalTexing�i;
COUNTY AUDITOR
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2p 20 _ 20
Counry
Is ihe property in quwtian:
❑ Real Pfoperty ❑ Mobile Home (IC 67.
��0 �,- 35�3 ���
Dra�verN ... ]Na
C�3�1'(� ��. ....
..... ....
-<-�v, ,(l.t'cr� � �53, 9GG�
.Z{�
20 _ � 20
day, yea�
I/ We certify under the penatry oi perjury that ihe above and foregoing infortnation is true and corred and that the apPticants was / were a residenl of
Indiana and owner of ihe afwementioned property on March 1, 2b
ina4ue (ownefslWl name) . � Oate (month. day, yea�
dlY. sfaf�and ZIP mde)
Paver of fLLlm�ey a by IC G1.1-1
AOtlrr.ss af aulhor¢ed prlsan (num6er antl shaet
wde)
Dale (monN. day, yean