HomeMy WebLinkAboutMortgage_Frantz (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ , FOR DEDUCTION FROM ASSESSED VALUATION
• . ' � Sfata Form 43709IR71 / 6-09)
�' ,u. � PresvibeE Gy DePa�M of Lo�l GovemrtreN Finance �
wsrnucnoNS:
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Fam filed with:
b 6e filed in person w by maii witA the Counry Auditor or Counry Recorder of the tounry where the property is locateda P�
Fil'mg Dates: i) Real Property: Must file durirg the year for which tha deduction is sought. 9 unty Auditor
2) Mobde / Manulectured Homes rpt assessed as Real Property: Mus! file dunng the hveHe (12) months
betore March 37 oi each year Ne deduction rs sought. � Counry Recorder
See reverse side /or adtlRionel instruclions and qualificatrons. a� '°'
__ . _' 6_ao �17
tl reln a mal p�opelty as of Mortgage/ Contraa i�dehtedness w
'Me�tli 1. amnl Y� MeIU t. Wrtenl � �
If m. what Ls his I hc e�d slwe ot Nterest?
H name m tcmO b m}lumt tl�an Nat of appOCa� Ntl�te Gebw.
Name of nnrtgagee v convarl ee0er
Addr� W rt�atpagee a cantrad seAer (num6er '. ste[e, arN Z!P mde)
rc.holder of rtartgag�
llrawer \'O...s7�.Q� �.......
C�l'C] �'�......�.��.......
��� y �, �
iT
I I We cerOfy under the
ownerlcontractbuyer
1raGire.(ow�erY MI nartre:
RemrO nwnber Page num6el
� {� 00 � OS3 / �
QMOriqag Pl�� inCehtedness unpak as o �i � t ttm �
❑ Yes ❑ No
If ox+�ed wiN sortKOne othu than spouse.
�a�
vhet munryt Wtpt Ta�dn
COUNTYAUDROR
��a
ly of pe�ury that e ahove and fa
atwementioned perty on date
ss W app�cant (num6ei ane.weeL dry, s+are, a
S S F5C) E �:..
Oy dWy exewutl Power UAttaney or by IC 6'
Pddress ot aultw�'ved persa� (num0er a�d sfreet �+0: �re. antl ZIP code)
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is the property in 0�: �nusly Assessed
❑ Real ProPenY ❑ ��Y �
Alobik F�lortie (IC 61.
Has Na dedWim Daen reVUeSted on papcly
ro� w�� y�n n.._ _ n
20 _ � 20 _ I 20
intortnalion is We and cortect ar�d Nat �he applit�nt is a resident of IrWiana arW
ion Ls filed.
Date (rtuntlt. daY• Y��
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oa�e ��«,m. e�: r�o