HomeMy WebLinkAboutMortgage_Payne"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS � Year
:,--
FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Form 43709 (R71 / 6�09)
�` ,w Prcwibetl by DepartmeM o( Local GovemrneM France
File Mark
srRUCnoNS:
«ro e wi :
. o be filed in person w by mail with the Counry Auditor or Counry Recolder o! Ne counry where the property is located.
Fd'mg Dates: 7/ Real Pmperty: Must file dunrg the year (of whicA the deduction is sough[. ��. �,geenty Audiwr
2) Mobi/e / Manu(adumd Homes irot assessed as Real Pmperty: Must fi7e danng [he tweNe (72) months t\ \
6etora Malch 37 of each year the Aeduction is sotght ❑ Ubu�Recordu
See reverse side !or adffitiunal instnn;tions and qualificatons. GIBSO
MP��I (owr�q{ ormntraC DuYer - see resfrkt�s m rerxrse sitle)
7aA ' bia %7l KeY �wm z �ga1D `/ 3 �l O� ^ � / � / R � mDU Page num6er
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As¢sscd rWie d rral property as d A1ortqaq e/ ContraG'uMebtedriPSS unpaid as ot Alongage / ConUaG'vWebtedness unp2id az of h Ne eP�� Ue sole
NarM 1, amvri Y� Marrh 1, airtrnt ymr tlate W aPP�� � ro eWdable o�neR
' � ❑ Yes ❑ No
If no. what Is ttis / her e� shara of interest? tt wmed wiih someane dher Man spouse. iMiqte with whom
If fwrie m rem�d'a dMerent lhan Nat al appfimn� 6Nicate bebvr. Is Ihe property in puesDOn: MnuaDy Assessed
� Real ProPe�Y � ��Y �
Modle F�lome fIC 61.1-�
Name ot rtnrtgapee or convact se0er
Pddress o( mat9a9ee w contracl
owner w nmer rn mongage
state, arN ZIP code)
(numoer arw suee4 �'. s,a�e, erw c�r coae�
Ooes a�plifam oxn property in any oNer I If yes,
counry m Intliana?
❑ Yes ❑ No
20
Sig�awre of Counry
—
��y�,�� ,�o,��.� �
20 _ � 20 � 20 � 20
Caunry
1 �-�a�o ���,
es ❑
20 _ � 20
I/ We certify u�Mer �he penalry of perjury Ihat Ne above arW toregang infarmalion is We and correct arM that Ne applitant is a resident of I�iana and
owner I contract buyer ot the afwementioned property on date appliqtion is filed.
�ria�Ye (o /p /W reme) Date (rtmN. deY. Ysa�
Fu0 �esiEent address oT ap
�c �7n,//I � S
tiry, sfare, antl
by IC 61.142-0.7
of authoraetl persm (number arM street, ciry, slate,
G
Date (mon(h, tlay. Yxa�