HomeMy WebLinkAboutMortgage_Buck (3)__rySTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
; FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709IR71 / 6-09)
•� � PresaiDed by DepartmeM of Lopl Govemmerd Fuarce
� File Mark
INSTRUCTIONS:
To 6e (ied in person w by mail with fhe Counry Audita or Counry Recorder ol the county wFiere fhe properry is located. � U F
Filing Dates: 7) Real Prope/fy: Must file dunng the yrear (or whicA the deduction is sought. Coun Auditor
2J Mo6de / Manu/actured Homes rrot assessed as Real Prnperty Must file durirrg the fwelve (12) montAs C� ry
before Ma�ch 37 of each year the deduction is sought. ry Recorder
See reverse side lor addiUOnal insWCUons and qual�catrons. G I BSON C U
AoobranlfownerorcontrdGbuver=seeresLiriniuonreversesidel �
�
ro.
� �i/G. �CIYLM �CY.I[.0 �
Key mimCer I legal tlesaiption
a-zG - - �o a� / 7 - o0
Mortpage / Contrart'uWe6tetlness unpaid as of Mortgage /
Mard� 7, a�rent year date of ap�
name m recad is Eilferent Nan Mat of applKant
Hame m mwcgayee
P4dres of nwrqagee w contrad seGer (nwnbe� arr/ stree; ury, sfeR, aM ZlP oode)
��a
Dces a�qinnl wm pmperty in any other I If yes. whal munry?
counry m I�iana? ❑ Yes
, � ❑ No
�
unpaid as of is Ihe app6rant Me sole
legal a equitade owre(.�
❑ Yes ❑ NO
som�ne oNer Ihan spouse. ind�te wiih Mom
h t� WoPenY in 7unstirn: MnuaOy AssesseC
P�opeM ❑!{n^uaMAs�ed
��'
Dra�� er �0 °�.l(': ,• •.:.. ...
a�o� .
..; .
c�ra���;�o:aO'.. _
20 � 20 � 20 � 20 _ � 20
v�r
❑ No
I/ We certify urWer the penalty of perjury that the above aM foregoing informalion is We and correct arM Mat ihe applinnt is a resident of InAiana aM
owner I mntract buyer of Ne aforemenlioned property on date applicatlon is filed.
p'anye(oxRerYl�^a^re) /l ... Date(mo�.EaY.Y��
FW re4tlent
%G
authoi@ed oy tlury
o(AUOrt�eY � �Y IC fr1.1-12-0.7
Addre55 of authotrzed persan (number and sbeet, cRy, slate,
�ate (manN. OaY.Yee�)