HomeMy WebLinkAboutMortgage_Mabrey"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sta[e Fortn 43709 (R11 / 6-09) °
�' ,�,� ° PresaiEeE M OeP��M of Lo�l Govemmenl Frarrx
de Mark
INSTRUCTIONS:
To 6e �led in person or by mail with the Co�nryAuditor or Counry RecoNer o/ the county where the property is located.
Filmg Dates: 7) Real Property: Must file during the year for which (he deduction is soughf.
2� Mo6ile / ManWactu2d Homes not assessed as Real P�operty: Musf fiie dunng the twelve (72) months
bePole Maich 37 0! each year tAe tleduction is sought.
See reverse side for 2dditional insWCUwis and qualifications.
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11 no, what is his / her exaG share ol interest?
If narne m remd 5 Eilfuent Nan that of app6cant, uMifate 6eb�r.
Name oi mort92gee or mnVatl se0er� �
Pddress of rtnrtgagee ar cantrad se0er (numbei and shee4 ury. stale, aM LP �
Name of asignre or dha ovmer or twlder of morigage
Atltlress oi asvgnee (number aiM street �: sfate, ar�d ZIP cotle)
applirant am praperty In any ofher I If yes, whet
v in Ind'gna7 ,--, ,--,
i numha Page number �
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H ow�ed vriN wmeone ahe . -
Dra�ti�er NO..��i........
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What Ta�arg DisVirl? I Ha5 ihis deduction Deen `eQUeSLM on propeny
fm wrrent yea(.� i--i _ �,
- couNrr auorroR
Dsfuclion approued'v� Ne amount of. I
20 20 20 _ 20 20 _ 20 20 _
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Sigreture ot Coimb AudMr ��\ Counry Date (monlh. eaY. Yea�
I/ We certlfy undv Ne penalry of perjur� that the above arW faregoing infortnation is We and cortecl and Nat the applinni is a resident of IMiana and
owner I mntract buyer of the aforemerrtioned properry on date application is filed.
Sigre re(awne/s Date (nmfh. daY. Yae�)
FWI ' e appGbn (numberand M}; state. and Pootle T //
Q l `f �
Pe1srn authw'¢N by duty esearteC Power af AvorneY � M IC 6.1-12-0.7 Date (monN. Ozy. yea�
Pdtlress of autha¢Ed person (num0er aM sbeet. city. sfafi. aM ZIP mde) .
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