HomeMy WebLinkAboutMortgage_King"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
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FOR DEDUCTION FROM ASSESSED VALUATION ,
� �• State Form 43709IR71 / 6-09)
�' � PreuribeA by Departmenl of Lowi Govemment Frence
w.
�STRUCTIONS:
To be filed in person of by mail with the County Auditor or Counry Recorder of the county where the pioperty is located.
Filirg Dates: 7J Real Pmperty: Must file durirg the year fo� which the deduc0on is soughf.
2) Mobde / Manufactured Homes nof assessed as Real Property. Must fite dunng the lwelve (72) months
before March 37 0( each year the deduction is saght.
See reverse side !a addifional instructions end qualfications.
i1pq4Fant(ownerorcontracfbuysr-se�restm-liorismreverseside) �� .
I( no.
Remrder
Key niun6er / le9al 4escriGtirn � Remrd munbu Pa9e wmbPi
a�o-ao..33_ oo-oo/. 9ys_oo/ d.ol}- /33�
MM�a ge / ContraG "uWehtedness unpaid as U MMgage I Contratt ieMebiedness �mpaid as d N' the epplirant Ne sole
Mardi 1, artent yeer date of apPlintion �egal w equibNe ameR
9 �� ❑ Yes ❑ No
intrlest? If owne0 wiM someorie mher than spouse. h�drafe w1C� whom
on �ewrd's drtferent Nan that af app6rant, h�dicate beb�r.
Name ol mwcgagee or mntraG
ALdress ol rtnrtgagee or wntrad
owner w ndaer ot monpage
crty, siate. ard ZIP code)
Mare55 ot assignee (number entl stree4 �Y. sfale. and ZIP CQCe)
s E 33 - 3
Dces apd�nt ov.n pmperry in any oNer If yes, what
munrymindana? r'7 .,__ f'1 .�_
amount ot
20 _ I 20 _ I 2Q
SigiaturedCoun AWimr
� - T.
I/ We certify unEer ihe penalry ot perjury 4j�the above
owner I contract buyer of the aforementio�ied property�
io�67 5 g5[
Prisw� auNOiaed by Euty executed
anE strect, dry, stare, anC ZIP
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VJhatTa�dng DisVict?
COUNTYAU�ROR
Is ihe P�PertY in GursEm: MnuaOy Assessed
❑ rte� a�oaerH ❑ ami,a�iy assessed
D1':1�1'CI' �i�.G.7u.i'.�..,:;....
�
' _ .� ,'
33�..�.
ca�-� �o. ..........<........
� 99,'1 W . � � �°�
20 I 20 I 20
Counry
�Y. Y��
20
regoing infortnalion is We and cortect arW ihat the applicant is a resident of InCiana aM
appliption is filed.
AGtlr¢s ot authoraed persa� (number arM sfreet �y, stale. antl ZIP code)
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