HomeMy WebLinkAboutMortgage_Schapker"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o ' s Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION �
Sfate Fortn 43709 (R71 / 6-09)
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Fle Mark
wsrRUCnoNS:
To be filed in person w by mail with Ne CountyAuditor os Counry Recorde� of Ne county where fhe propeRy is located.�%js F�or�m�R ��
FiHng Dates: 1) Real Property: Must file dunrg the year (or which the deduction is sougAt. �}';�C� �udita�
2) Ab6Ae / Manufactumd Homes not assessed as Real Property Must file dumg tAe tweNe (12J �N C UN Fi�i �u��
6efore Ma�ch 37 of eadr yeer the deduction is sought. LJ �nty Recwder
See ,everse side /or addilional instruct'ons and quall(ications.
I Aoo�cam (owner or.contraG burBr- see iesinUions m reversa s:�E)
T' isbvi - Key rum0er / legal desmpti
o - - ��
Asrsessed rahie � rnal qoperty as of Mpr�p�g e/ Conn
MOrh 7. MPnt Ymr Mamh 7, a�rtent
�I
I( m. what Ls lus I twi e�mG share Of interesl?
mG
It na�re m remtl s ddfMalt Nan Mat of ao�taril'uMifate bebw:
Nameafmortgag ormnVaUSeDer
�-
Address of nnrtgag r mn a seAei
Does applirant avm praperty in any ahu
counryi Miana?
❑ Yes
DeEuaion app�oved in Ure amount of.
�a
stete. ane
I n yes. wnac munry�
No
-oaG. 9�
�A�s unpaid as of
SoTCOne
RemrO number Page numDer "
ao ,S
irMeMedrass unpaN as ot Is Ihe eppi'xant Ne sde
legal w equda6le ownell
❑ Yes ❑ No
han spouse. i�dicate wfih wlwm
Ls e yoperty m Ouesaon: MnuaOy Ass¢sed
.Real Pn?PertY_❑.A!inuallY_ .A� 1.1-�
(';� �c�-- %�h���'"
�oi u - s9R �
� 55; m�o . �
ip(openy
20 _ 20 _ 20 20 _ 20 _ 20 _ 2(1 _
Sigriawre d Co�mry nWitor \ I Counry Date (r+pntn. daY• Y��
I I We certfy uMer the penalty of perjury that the ahove and foregoing infortnaUon is We and cortect aM that the applirant is a resident of IrWiana arW
owner ! mntract buyer ot the afo2mentiwied property on date application is filed.
Slgrunue (owner's !� name) Date (monN. daY. Yga�
7�"}�1.�.���� ��i,a.�,k,�
FWI resMent addres W aPP�t (num rand shee4 � te. ard Z1P code7 n'_ n .. _. .
Date (mmN. daY. Y��
.4dd2ss ot aWw�'ved person (number eM stree; city, state, arM Z!P code)